Septic clinical syndrome developed in a 61-year-old man 18 months after he had received a permanent pacemaker implant. Blood culture was positive for coagulase-negative staphylococcus, and pacemaker-lead vegetation was detected with transesophageal echocardiography but not with transthoracic echocardiography. Surgical intervention was necessary. Surgical findings were pacemaker-lead and tricuspid-leaflet vegetation. Transesophageal echocardiography proved useful in detecting pacemaker-lead vegetation.