case_images: PMC7399732_01
case_images: Patient's chest at initial presentation to the emergency department, with erythematous fluctuance at the pocket of his previous right-sided pacemaker visible.
case_images: CRIID2020-8883907.001.jpg
case_images: PMC7399732_01_CRIID2020-8883907.001.jpg
case_images: fig1
case_images: A 52-year-old man with a past medical history significant for uncontrolled type 2 diabetes, remote traumatic brain injury, and complete heart block of unknown etiology presented to the emergency department (ED) due to symptomatic hypoglycemia, intermittent fevers and chills, and a swollen, erythematous, tender fluctuance at the pocket of his previous right-sided pacemaker that had been removed years ago, as seen in Figure 1.
case_images: Each C. acnes-positive blood culture in relation to the time at which the patient was diagnosed with infective endocarditis.
case_images: CRIID2020-8883907.002.jpg
case_images: PMC7399732_01_CRIID2020-8883907.002.jpg
case_images: fig2
case_images: An overview of the circumstances surrounding the patients most recent and six previous C. acnes-positive blood cultures, as well as a timeline of these blood cultures, can be seen in Table 1 and Figure 2, respectively.
case_images: Transesophageal echocardiogram showing 1 cm vegetation (red arrow) adhered to the tricuspid valve suggestive of infective endocarditis.
case_images: CRIID2020-8883907.003.jpg
case_images: PMC7399732_01_CRIID2020-8883907.003.jpg
case_images: fig3
case_images: This study was performed on HD 9 and revealed vegetations across multiple pacemaker leads, highly suggestive of infective endocarditis. The largest vegetation was 1 cm in diameter, as seen in Figure 3.