Percutaneous thrombectomy assisted lead extraction: successful diagnosis and treatment in a case report of culture negative endocarditis

Background: Propionibacterium acnes is a rare cause of prosthetic valve endocarditis and implantable cardiac device [implantable cardioverter defibrillator (ICD)] endocarditis. Previous reports of P. acnes endocarditis have described various approaches to treatment. Treatment of P. acnes endocarditis with AngioVac extraction (AE) is unreported. We describe a case of P. acnes ICD endocarditis that required AE to facilitate device extraction and ensure successful treatment of endocarditis. Case summary: The patient presented with classical symptoms of fever, fatigue, night sweats, and chills for 3 weeks. Serial blood cultures were negative. Cultures from skin were positive for P. acnes. Transthoracic endocardiogram and transoesophageal echocardiogram demonstrated vegetations adjacent to the transvenous leads and on the septal leaflets of the native tricuspid valve (NTV). Due to vegetation size, AE was performed to debulk the vegetations prior to lead extraction (LE). Vegetation cultures were also positive for P. acnes. He was prescribed i.v. antibiotics post-operatively and had an excellent long-term course with no further endocarditis episodes or complications at 3-year follow-up. Discussion: Our case is one of the first to demonstrate the extent to which the integumentary pathogen P. acnes is involved in cardiac infections. It is also the first literature-reported case to utilize AE to treat P. acnes ICD endocarditis involving the NTV. This case illustrates the utility of AE in vegetation debulking prior to ICD LE and in identifying atypical pathogens where conventional diagnostic tests are unable to detect a pathogen.