A 59 year old man was hospitalised for clinical signs of sepsis (methicillin resistant Staphylococcus aureus) with two large bacterial vegetations adherent on his automatic implantable cardioverter-defibrillator (AICD) lead in the right atrium and superior vena cava (panel A). Eight weeks earlier, septic ulcers first appeared on both chronic ischaemic legs (obstructive peripheral arterial disease) due to a 30 year history of insulin dependent diabetes mellitus (including diabetic nephropathy with chronic nephrodialysis since five years previously). The AICD had been implanted 15 months earlier, …