Traps and Tricks About A 6-Years Old Cutibacterium Endocarditis

Endocarditis of cardiac implanted electronic devices is a complex and serious disease. Commensal bacteria of the skin are commonly considered as contamination of blood culture. Herein, the authors report the case of a pacemaker endocarditis with cultures positive for Cutibacterium acnes. These were already found 3 and 6 years ago but not observed during hospitalisation. The PET-scan was of great help in guiding the diagnosis. The management was particularly difficult with 9 leads to extract. A sequential approach in the operating room from endovascular procedure to surgery under cardio-pulmonary bypass was used. A second procedure was necessary to extract a small forgotten foreign body already visible on the preoperative chest X-ray. This experience shows the importance of having a high level of suspicion in case of culture positive for Cutibacterium with intracardiac devices, and of looking for foreign bodies on the preoperative chest X-ray in case of a history of multiple rhythmological procedures.