Aspergillus Infection of a Permanent Ventricular Pacing Lead J. RANDALL MOORMAN, CHARLES STEENBERGEN, and DAVID T. DURACK From the Departments of Medicine and Pathology, Duke University Medical Center, Durham, North Carolina MOORMAN. |.R., STEENBERGEN, C, AND DURACK. D.T.: Aspergillus Infection of a permanent ven- tricular pacing lead. Fungal infections of intracardiac pacemakers are extremely rare. We describe what appears to be the first reported case 0/Aspergillus infection of a permanent pacing lead and review the three reported cases of other fungal infections of pacemaker leads which we couJd find in the literature. These infections maybe encountered morefrequendy as the number of permanent pacemakers implanted in elderly patients with underlying medical illnesses continues to increose. [PACE, Vol. 7, May-/une, 1984) aspergillus, endocarditis, pacemakers Introduction Infection is an infrequent complication of per- manent pacemakers.' -^ Bacterial infections occur in only one to three percent of the patients in most series and usually involve the subcutaneous pocket housing the pulse generator, Fungal infections of pacemakers are even more rare. We report a case of Aspergilius flavus pacemaker lead infection, and review the only three cases of pacemaker lead in- fection due to fungi that we could find in the lit- erature. Case History M.H., an 80-year-old woman with diabetes, was admitted to Duke University Medical Center in June, 1981 for evaluation of a febrile illness of three months' duration. In 1975, a permanent transvenous pacemaker had been inserted from the left subclavian vein for high degree atrioventric- ular block. The pulse generator was changed in Address for reprints: David T. Durack. MB.. D. Phi]., Box 3867, Duke University Medical Center, Durham, North Carolina 27710 U.S.A, Received September 2, 1983; revision received October 13, 1983; accepted October 20, 1983, 1976 because a high failure rate had been expe- rienced with that model, although hers was pacing satisfactorily. In April 1980, she presented again with an ep- isode of faintness. An electrocardiogram showed intermittent failure to capture, and the pacing threshold was very high. A second permanent transvenous pacing system was established in the right subclavian vein; the original pacing lead was left in place. The patient was well for six months, and then developed right lower lobe pneumonia. This re- solved witb antibiotic treatment. One month later she developed left lower lobe pneumonia, which also resolved with antibiotics. However, she felt generally ill for the next four months and in March, 1981 she developed fever and chills. A month spent in a local hospital generated negative blood cul- tures, a negative gallium scan, and no lasting re- sponse to empiric antibiotic therapy. She was transferred to Duke University Medical Center, where she was found to have temperatures of 39°C and a grade II/VI hasal systolic ejection murmur. Her chest roentgenogram showed linear densities suggesting atelectasis. An echocardi- ogram showed a small dense target in the right ventricular apex at the tip of the pacing lead, thought to be a small mural thromhus. There was moderate anemia with evidence of hemolysis: multiple blood PACE, Vol. 7 May-June 1984, Part I 361