Coronary artery stent infection presenting as coronary cameral fistula: a case report

INTRODUCTION: Coronary artery stent infection is a rare event. We report a case of delayed coronary artery stent infection with coronary cameral fistula presented as pyrexia of unknown origin, 1 year after coronary intervention. CASE PRESENTATION: A 66-year-old man presented with paroxysmal low-grade fever of 2 years duration. He underwent percutaneous coronary intervention (PCI) with stent to right coronary artery (RCA) for inferior wall myocardial infarction in July 2014. He had non-ST-elevation myocardial infarction in December 2014. Repeat PCI with two stents to same vessel was done for total occlusion of stent. Repeated evaluations by family physician for fever did not yield any discrete diagnosis, and he was treated with empirical antibiotics. He had worsening of fever since last 2 months. Whole body positron emission tomography scan showed increased tracer uptake in RCA with perivascular abscess involving lateral wall of right ventricle. Coronary angiogram showed presence of small coronary cameral fistula from RCA draining into right atrium. Blood cultures grew Pseudomonas aeruginosa. He was taken for surgery and the infected portion of the RCA including the stents was removed. DISCUSSION: This case reports delayed coronary stent infection. Patient presented 1 year after procedure. Presence of bare metal stent increases risk of infection in presence of bacteraemia. Antiproliferative effects of drug eluting stents may predispose more to infection. This case was unique in its late presentation, presence of coronary cameral fistula and was successfully treated with surgery.