This case report describes a pacemaker pocket infection caused by Campylobacter jejuni in an immunocompromised patient, emphasizing that subtle pocket changes without systemic symptoms may indicate CIED infection, and that early microbiological sampling, pathogen-directed antimicrobial therapy, and complete device removal remain essential for cure.
Key Findings
Background
Campylobacter jejuni caused a cardiac implantable electronic device (CIED) pocket infection in an immunocompromised patient, representing a rare gram-negative pathogen in this clinical context.
CIED infections are usually caused by gram-positive bacteria, whereas gram-negative pathogens are uncommon.
The patient was immunocompromised due to primary central nervous system diffuse large B-cell lymphoma and was receiving chemotherapy with corticosteroids.
The pacemaker had been implanted for sick sinus syndrome prior to the lymphoma diagnosis.
Both pocket fluid cultures and blood cultures grew C. jejuni, confirming bacteremia with secondary device seeding.
Results
The CIED pocket infection presented with subtle local signs and no systemic or gastrointestinal symptoms, suggesting silent Campylobacter bacteremia.
The patient exhibited swelling and subcutaneous fluid accumulation over the device pocket at first scheduled follow-up.
There were no local inflammatory signs and no systemic symptoms.
The patient had no recent history of diarrhea, abdominal pain, nausea, vomiting, or other gastrointestinal symptoms.
Inflammatory markers were only mildly elevated.
The absence of gastrointestinal symptoms suggests silent Campylobacter bacteremia with secondary seeding of the device pocket.
Results
Pocket aspiration yielded straw-colored serous fluid, and initial empirical antibiotic therapy was changed to targeted macrolide therapy based on susceptibility testing.
Initial empirical therapy was amoxicillin-clavulanate.
Antimicrobial susceptibility testing prompted a change to intravenous clarithromycin (targeted macrolide therapy).
Inflammatory markers normalized during continued antibiotic therapy.
Results
Transesophageal echocardiography showed no vegetations on the leads, and the entire pacing system was extracted as part of definitive management.
Transesophageal echocardiography showed no vegetations on the leads, distinguishing pocket infection from lead endocarditis.
The entire pacing system, including the generator and leads, was extracted.
Temporary pacing was provided following extraction.
After clinical stabilization, a new dual-chamber pacemaker was implanted contralaterally.
The patient was discharged without signs of persistent infection and remains under regular outpatient follow-up.
Conclusions
Subtle pocket changes in immunocompromised patients may indicate CIED infection even in the absence of classic systemic symptoms, highlighting the importance of early microbiological sampling.
The case emphasizes that immunocompromised patients may present atypically with only subtle device pocket changes.
Early microbiological sampling, pathogen-directed antimicrobial therapy, and complete device removal are identified as essential for cure.
The case is presented alongside a literature review, as C. jejuni is a rare pathogen in this setting.
The authors conclude that clinicians should maintain a high index of suspicion for CIED infection even when systemic symptoms are absent.
What This Means
This research describes a rare case of a pacemaker infection caused by Campylobacter jejuni, a bacterium that normally causes food-borne gastrointestinal illness but very rarely infects implanted heart devices. The patient had recently been diagnosed with a type of brain lymphoma and started chemotherapy, which weakened their immune system. Despite having no stomach or digestive symptoms — which are the classic signs of Campylobacter infection — the bacteria had silently entered the bloodstream and settled in the pocket of tissue surrounding the pacemaker, causing swelling and fluid buildup.
Because the infection signs were subtle and there were no obvious systemic symptoms like fever, the case highlights how infections in immunocompromised patients can look very different from what clinicians typically expect. The medical team identified the bacterium by culturing both the pocket fluid and the patient's blood, then switched to the appropriate antibiotic (clarithromycin) based on lab sensitivity testing. The entire pacemaker system was surgically removed, a temporary pacing solution was used, and once the infection resolved, a new pacemaker was implanted on the other side of the chest. The patient recovered fully.
This research suggests that doctors should maintain a high level of suspicion for device pocket infections in patients with weakened immune systems, even when symptoms are mild or atypical and there is no history of gastrointestinal illness. It also underscores that successful treatment of such infections typically requires identifying the exact pathogen through microbiological testing, using the right antibiotic, and completely removing the infected device rather than treating with antibiotics alone.
Barańska-Pawełczak K, Ziaja B, Opara M, Jacheć W. (2026). Campylobacter jejuni as a Rare Pathogen in CIED Pocket Infections: A Case Report and Literature Review.. The American journal of case reports. https://doi.org/10.12659/AJCR.953738