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Case report
A case of fever of unknown origin and recurrent hospital admissions in a cardiac patient: emergence of Enterobacter cloacae
  1. Syed Emir Irfan Wafa1,2,
  2. Raheel Ahmed1,
  3. Kay Teck Ling1,3 and
  4. Peter Carey1
  1. 1 Cardiology, University Hospitals of Derby and Burton NHS Foundation Trust, Burton on Trent, UK
  2. 2 Cardiology, University Hospitals of Leicester, Leicester, UK
  3. 3 Stroke Medicine, University Hospitals of Derby and Burton NHS Foundation Trust, Burton on Trent, UK
  1. Correspondence to Dr Syed Emir Irfan Wafa, syedemirirfan.wafa{at}


A 72-year-old gentleman with significant cardiac history and a pacemaker in situ initially presented to the emergency department 5 days after he had his pacemaker-unit batteries changed. He had deranged vital signs, productive cough and fever. His chest plain radiograph did not show evidence of infection; however, he had right basal crackles on auscultation, which suggested a lower respiratory tract infection. He was treated with intravenous co-amoxiclav and supportive therapy, which led to his improvement. The patient was discharged but had to be readmitted a total of four times over the span of 4 months due to recurrent fever and associated symptoms. Transthoracic and transoesophageal echocardiograms and CT of the neck/thorax/abdomen/pelvis were done to look for endocarditis, pacemaker-unit infection and other sources of infection. However, these did not show any evidence of infection. He did have persistent raised inflammatory markers and two blood cultures growing Enterobacter cloacae. A fluorodeoxyglucose positron emission tomography scan was done, which showed evidence of pacemaker lead infection. His pacemaker unit was removed, which led to cessation of his symptoms and normalisation of his inflammatory markers. He had no further hospital admissions to date and has been regularly followed up in an outpatient cardiology clinic.

  • cardiovascular medicine
  • interventional cardiology
  • infectious diseases
  • radiology
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  • Contributors SEIW and RA thought up and planned the design of the work. KTL was involved in data collection, whereas SEIW and KTL were involved in analysing and interpreting the data. RA obtained written consent from the patient. PC supervised and directed the flow of work. SEIW drafted the article and the all coauthors critically revised it. Final approval of the version to be published were agreed by all coauthors involved. SEIW was previously employed by the Queens Hospital Burton Foundation Trust, (now known as University Hospitals of Derby and Burton NHS Trust (UHDB NHST)) when this project was carried out. He is currently employed by the University Hospitals of Leicester NHS Trust. The other coauthors are currently employed by the UHDB NHST.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Obtained.

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