Abstract
In March, 2009, a 54-year-old man attended the pacemaker clinic for routine review. He described a 20-month history of intermittent episodes of rigors and fevers (temperatures up to 39·3°C) associated with myalgia and arthralgia predominantly related to severe physical exertion and sexual intercourse. His medical history included: a dual chamber permanent pacemaker (PPM) implant for sinus node dysfunction in 1992; a change of generator box in 2006; and melanoma excision in 2007. 18 months earlier he had undergone lumbar laminectomy and 6-week treatment with flucloxacillin for discitis due to coagulase-negative staphylococcus. Over the following months he presented to several specialists for investigations of these symptoms.
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