Pacemaker lead-related endocarditis with Neisseria sicca

We report the first known case of Neisseria sicca-associated pacemaker lead endocarditis—a disease whose incidence and mortality are growing. A woman in her 70s with a history of transcatheter aortic valve replacement and pacemaker placement 7 months earlier presented with recurrent fevers. She visited the emergency department several times during the past 2 months for these fevers, and she had been given oral antibiotics for presumed urinary tract infections. Investigations revealed blood cultures growing N. sicca. Although transthoracic echocardiogram was negative, transesophageal echocardiogram showed two vegetations on the right atrial lead which suggested pacemaker lead-associated endocarditis. A complete pacemaker and lead extraction was performed, and the patient recovered completely and was discharged home to complete 6 weeks of intravenous ceftriaxone with plans for follow-up echocardiography. We hope that this case will contribute to the growing body of literature regarding device infections, thus leading to earlier identification and treatment.