Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Aug 6, 2019; 7(15): 2103-2109
Published online Aug 6, 2019. doi: 10.12998/wjcc.v7.i15.2103
Fever and neck pain after pacemaker lead extraction: A case report
Shao-Xian Wang, Jian Bai, Rui Ma, Rong-Fang Lan, Jia Zheng, Wei Xu
Shao-Xian Wang, Department of Cardiology, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing 210008, Jiangsu Province, China
Jian Bai, Rui Ma, Rong-Fang Lan, Jia Zheng, Wei Xu, Department of Cardiology, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing 210008, Jiangsu Province, China
Author contributions: Xu W and Lan RF designed the report; Bai J, Ma R, and Zheng J collected the patient’s clinical data; Wang SX analyzed the data and wrote the paper.
Supported by Nanjing Foundation for Development of Science and Technology, No. ZKX14018.
Informed consent statement: Consent was obtained from relatives of the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Wei Xu, MD, Chief Doctor, Professor, Department of Cardiology, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, No. 321, Zhongshan Road, Gulou District, Nanjing 210008, Jiangsu Province, China. 13390900868@163.com
Telephone: +86-25-83106666 Fax: +86-25-68182812
Received: March 8, 2019
Peer-review started: March 11, 2019
First decision: May 10, 2019
Revised: May 14, 2019
Accepted: June 26, 2019
Article in press: June 27, 2019
Published online: August 6, 2019
Processing time: 151 Days and 20.9 Hours
Abstract
BACKGROUND

Venous thrombosis (VT) is one of the minor complications of pacemaker lead extraction. It is often found due to the swelling of the limbs after the extraction. It is easy to be neglected or even misdiagnosed in the absence of typical clinical symptoms. The incidence, risk factors, and long-term impact of this complication are still unclear. Herein, we report a case of deep VT caused by transvenous lead extraction, which is easily misdiagnosed.

CASE SUMMARY

A 66-year-old woman underwent a pacemaker lead extraction at our hospital because of a pacemaker pocket infection. After the extraction, she began to experience intermittent fever accompanied by sweating. The highest body temperature recorded was 37.9 °C. Additionally, she reported migratory pain that made her uncomfortable. The pain was mistakenly thought to be caused by operation trauma. At first, the pain radiated from the left chest to the mandible. Then, the pain in the left chest was alleviated, but pain in the left neck and throat appeared. Finally, the pain was confined to the mandible and a submandibular mass was palpated with no other abnormalities upon physical examination. Computed tomography venography and angiography finally indicated that the fever and pain were the symptoms of thrombophlebitis caused by lead extraction. The patient was then treated with rivaroxaban for more than three months and has shown no symptoms since she left the hospital.

CONCLUSION

The possibility of thrombosis should be considered when pain and recurrent fever occur after pacemaker lead extraction.

Keywords: Venous thrombosis; Lead extraction; Neck pain; Fever; Anticoagulants; Case report

Core tip: Deep venous thrombosis caused by transvenous lead extraction is easily missed. The exact incidence is still unclear. Thrombosis after lead extraction during hospitalization should be identified early even without typical symptoms such as edema. Additionally, reasonable and standard anticoagulation therapy after lead extraction should be considered in the future.