Elusive Enterobacter cloacae causing pacemaker endocarditis

An 80-year-old patient was admitted for fever, chills, and chest wall pain. He had a past medical history significant for heart failure with a cardiac resynchronization therapy pacemaker implantation. Extensive workup revealed Enterobacter cloacae endocarditis of the pacemaker leads and the mitral valve, a rare etiology with an unidentified source in our patient. He was managed with a rather unconventional method which proved to be successful. This case sheds light on non-HACEK (other than Haemophilus spp., Aggregatibacter actinomycetemcomitans, Cardiobacterium hominis, Eikenella corrodens, or Kingella spp). gram-negative organisms, and particularly E. cloacae, as uncommon causes of endocarditis with elevated mortality, and discusses potential treatment modalities. (C) 2021 The Authors. Published by Elsevier Ltd.

Automated summary

An 80-year-old patient with a history of heart failure presented with fever, chills, and chest wall pain, and was diagnosed with Enterobacter cloacae endocarditis. Despite the unidentified source, he responded well to unconventional treatment, highlighting the importance of considering uncommon pathogens in cases of endocarditis.