Two weeks after dual-chamber pacemaker implantation, a 51-year-old man presented typical signs of pacemaker pocket infection and sharp pain in the left shoulder with functional impotence of the limb. Device and leads were explanted. Pseudomonas aeruginosa was isolated in culture samples obtained from the pocket tissue and both lead tips; blood cultures remained sterile. Specific antibiotic therapy with intravenous ciprofloxacin and cefepime was started. Transoesophageal echocardiography ruled out intracardiac vegetations. Magnetic resonance imaging (MRI) showed acute osteomyelitis of the left clavicle (Panel A). After discharge, a further MRI revealed a mild reduction of the infected focus; antibiotic therapy was discontinued. Nine months later, a nearly complete resolution of the osteomyelitic focus was observed and the patient regained a full functionality (Panel B). The quick beginning of specific antibiotic therapy, the good susceptibility profile of the microorganism and the absence of comorbid conditions probably contributed to the good prognosis.
The full-length version of this report can be viewed at: http://www.escardio.org/communities/EHRA/publications/ep-case-reports/Documents/Osteomyelitis-of-the-clavicle.pdf.
