Permanent pacemaker lead infection is a rare condition but can be fata
l, and may be accompanied by a number of complications. A clinical dia
gnosis is feasible, though it can be difficult. We report two patients
with permanent pacemakers who developed fever of unknown origin with
several habitual features of pacemaker lead infection. Transthoracic e
chocardiography (TTE) was not definitive, while transesophageal echoca
rdiography (TEE) detected vegetations on the electrode tips. The main
clinical features suggesting this condition are described. The usefuln
ess of echocardiography for diagnosis and patient management are discu
ssed.