Pacemaker infection with Mycobacterium avium complex.

A 21-year-old. HIV negative, malnourished, homeless woman with congenital heart block had a pacemaker implanted at 7 years of age and multiple procedures thereafter. The most recent of these procedures was replacement of a pulse generator in the right pectoral region. Four months later she had fever, pain, and swelling over the implant site resulting from infection with mixed flora and Mycobacterium avium complex. The pacemaker system was removed by thoracotomy via a median sternotomy and a new DDD pacemaker simultaneously implanted. She was treated with systemic antibiotics--isoniazid, rifampin, ethambutol--for 2 weeks. Six months later she was healthy, pacing well, and apparently free of infection, off all medications.