LETTER
Hippokratia 2012, 16, 4: 390
Gungor O1, Yalcin MM1, Ozel E2, Biberoglu K1, Topal K3
1Department of Internal Medicine, Faculty of Medicine, 2Department of Cardiology, Faculty of Medicine, Dokuz Eylul University, Izmir, 3Department of Medical Education, Faculty of Medicine, Pamukkale University, Denizli, Turkey
Keywords: Brucella spp, endemic region, pacemaker infection, papular lesion
Correspoding author: Ozkan Gungor, Dokuz Eylul University, Faculty of Medicine, Department of Internal Medicine, 35010 Inciralti/ Izmir, Turkey, tel: +902323904254, fax: +902323902053, e-mail: ozkangungor@yahoo.com.tr
Dear Editor,
Brucellosis is a zoonotic disease that often presents with fever and malaise, and it is sometimes complicated by unusual involvements such as meningitis, endocarditis and arthritis1. Pacemaker-related infections remain a severe form of complication after implantation, and Brucella spp. are rare agents of pacemaker infections2.
A 61-year-old man was admitted to the hospital with recurrent papular lesions on the pacemaker implantation site. Standard precautions were taken when placing the pacemaker into the patient to prevent the transmission of infectious agents. Two years after the repeat procedure, the patient complained of papular lesions at the pacemaker implantation site. A soft tissue infection was considered after initial examination, and intravenous sulbactam-ampicillin was subsequently administered to the patient. After the generator pocket was completely removed, the patient was followed up with an ECG-holter, which revealed no sinus pause or bradycardia. The patient was subsequently discharged without a pacemaker, but he returned to the hospital 15 days later due to the recurrence of the papular lesion on the same site. Blood culture specimens were obtained, and superficial ultrasonography was performed on the patient. Ultrasonography revealed an abscess and a fistula with dimensions of 42 x 15 x 20 millimeters. The remaining pacemaker leads were completely removed. B. melitensis was isolated by cultures from blood, sputum samples, drained materials from the abscess and the pacemaker pocket. A combination of doxycycline (2 x 100 mg/day) and rifampicin (1 x 600 mg/day) for 6 weeks was administered. The patient eventually recovered fully, and all blood cultures were negative for Brucella Melitensis after the treatment. In conclusion, brucellosis should be considered, especially in endemic regions for the pathogen, when papular lesions at the pacemaker site are observed.
References
1. Franco MP, Mulder M, Gilman RH, Smits HL. Human brucellosis. Lancet Infect Dis. 2007; 7: 775-786.
2. Francia E, Domingo P, Sambeat MA, Montiel JA, Pericas R, Sánchez F et al. Pacemaker infection by Brucella melitensis: A rare cause of relapsing brucellosis. Arch Intern Med. 2000; 160: 3327–3328.