Mycobacterium Fortuitum Device Infection with Subsequent Endocarditis

Case A 78-year-old female with a past medical history of mild dementia, hypertension, diabetes, coronary artery disease status post automatic implantable cardioverter defibrillator (AICD) for congestive heart failure presented with suspected bacterial endocarditis and AICD lead infection from an outside hospital (OSH). The patient initially presented to the OSH with chest wall tenderness, fevers up to 101° F, chills, decreased appetite, weakness and weight loss. She was diagnosed with a non-ST segment myocardial infarction based on elevated troponin levels without electrocardiogram changes. At the OSH, blood acid fast bacillus (AFB) cultures were checked after routine blood cultures and fungal cultures were negative. Three separate blood cultures grew out Mycobacterium fortuitum over 3 different time intervals at the OSH. The patient was started on trimethoprim/ sulfamethoxazole 160mg/800mg orally three times a day and ciprofloxacin 500 mg orally twice a day. It was decided that definitive treatment for her persistent bacteremia and suspected endocarditis would require removal of the device and leads. The patient was transferred to Thomas Jefferson University Hospital (TJUH) for AICD lead removal and temporary pacemaker placement