Rare case of very late coronary stent infection with resultant coronary cameral fistula and infective endocarditis: Diagnosis and management

Abstract

66yrs old, Male, presented to our hospital with history of low-grade fever of one month duration. Only significant past history was right coronary artery (RCA)stenting done a year ago. Physical examination no localizing signs of fever. Blood culture identified pseudomonas aeruginosa. Electrocardiogram (ECG) showed old inferior wall myocardial infarction changes. Echocardiography (ECHO) detected myocardial abscess along the right atrioventricular groove and vegetation on tricuspid valve. Coronary angiogram showed totally occluded and infected RCA stent with formation of coronary cameral fistula, draining into right atrium. A positron emission tomography (PET) scan and a computed tomography (CT) scan showed increased tracer uptake in RCA stent, peri-stent abscess. Infected stent, artery, and vegetation removed surgically, then graft given to distal RCA. The multi-diagnostic modality helped in identifying this condition early. Timely surgical intervention helped the patient to recover in otherwise life-threatening complication.

Keywords

• Coronary stent infection (CSI)
• Pyrexia of unknown origin (PUO)
• Myocardial abscess
• Coronary cameral fistula
• PET-CT