The utilization of fluorodeoxyglucose positron emission tomography/computed tomography in cardiovascular implantable electronic device infections in case of a negative transesophageal echocardiogram

Introduction: In the last decade, there has been an accelerated increase in the number of cardiovascular implantable electronic device (CIED) implantations. Similarly, CIED infections have risen significantly with a three-fold augmentation for pacemaker infections and a six-fold augmentation for implantable cardioverter defibrillator (ICD) infections. The complications of CIED infections may be critical, and related infections are associated with heightened risk of mortality. Most patients, who experience symptoms related to CIED infections present either a generator-pocket site inflammation or unspecific symptoms in relation to positive blood cultures or fever of unknown origin. The diagnosis is mainly supported by evidence of cardiac or CIED involvement by transesophageal echocardiography (TEE). Case Presentation: In this report, we describe a case of a CIED infection in a 49-year-old female, admitted in 2013 to a hospital in Copenhagen, Denmark, with persistent Staphylococcus epidermidis bacteremia without any clinical signs of generator-pocket infection and several negative TEE studies. Conclusions: The diagnosis of CIED infection was established with Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography (18F-FDG PET/CT) scan revealing clear evidence of infection localized to the vascular ICD lead and generator-pocket.