Bacillus Cereus Endocarditis in a permanent pacemaker: a case report

INTRODUCTION: Bacillus Cereus endocarditis is a rare condition which has been implicated in intravenous drug users, and in patients with prosthetic heart valves. We report a rare case of Bacillus Cereus infecting a permanent pacing wire. CASE PRESENTATION: A 69 year old female with a permanent pacemaker presented with rigors, sweats and weight loss. Blood cultures grew Bacillus Cereus; Transesophageal echocardiogram demonstrated a mobile lesion attached to the pacing wire. She was treated with appropriate intravenous antibiotics for 6 weeks with a good clinical recovery at 6 months follow up. CONCLUSION: This case reminds the clinician to have a high index of suspicion for endocarditis in any patient with cardiac prosthesis and to pursue the blood culture results even for rare and unexpected organisms. It also suggests the possibility of a trial of antibiotic therapy prior to prosthesis removal in select patients who are not in heart failure and hemodynamically stable.