The use of cardiac pacemakers is increasing worldwide. Infective endocarditis from a pacemaker lead is a rare, but one of the most severe complications of pacemaker insertion. The diagnosis of pacemaker-related infective endocarditis is usually delayed due to unspecific clinical signs and symptoms at presentation compared to native valve infective endocarditis. Several factors can increase the risk of cardiac pacemaker-related infective endocarditis including cachexia, malignancy, diabetes mellitus, immunosuppression and corticosteroid treatment. This case report is about a 70-year-old diabetic male who presented to the emergency department with disseminated intravascular coagulation (DIC), cardiac and liver failure. He was diagnosed with pacemaker infective endocarditis, which was ultimately fatal.

Background: Bradycardia and syncope are known sequelae of brain lesions. However, in the absence of neurological signs and symptoms, bradycardia and syncope are often investigated purely from the cardiovascular perspective and central nervous system-related causes may be easily overlooked during differential diagnosis. Case presentation: Here we report a case of a 69-year-old Caucasian man who presented to the emergency department after a fall. He had 1-year history of syncope and bradycardia with frequent ectopic beats shown on his electrocardiogram. He had no neurological symptoms. He was previously investigated as an outpatient and a diagnosis of idiopathic bradycardia with ventricular ectopic beats was made. On admission, cardiovascular investigations could not reveal the cause of his bradycardia. Computed tomography and magnetic resonance imaging scans of his head showed a localized mass in left basal ganglia consistent with infiltrating glioma. Conclusion: To the best of our knowledge this is the first case report demonstrating central nervous system-related bradycardia and syncope without other neurological symptoms. This case will serve as a useful reminder to general practitioners, accident and emergency doctors, and cardiologists.