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. 2020 Mar 12;4(2):1-7.
doi: 10.1093/ehjcr/ytaa049. eCollection 2020 Apr.

Pyoderma gangrenosum complicating a permanent pacemaker implantation: a case report and literature review

Pierre Frey  1 , Chrystelle Akret  1 , Didier Irles  1 , Antoine Dompnier  1 , Anne-Claire Bing  2
Affiliations

Pyoderma gangrenosum complicating a permanent pacemaker implantation: a case report and literature review

Pierre Frey et al. Eur Heart J Case Rep. .

Abstract

Background: Pocket complications are common after cardiac implantable electronic device implantation. We report a rare case of pyoderma gangrenosum (PG) complicating a permanent pacemaker implantation, and the first literature review of 10 published cases.

Case summary: Five days after pacemaker implantation for heart failure and 2:1 atrioventricular block, a 93-year-old man had pain in the scar and bleeding on contact. Two days later, he had fever, inflammatory syndrome, and a necrotic 7-cm wound. The pacemaker was removed and he was started on antibiotics. Due to a lack of bacterial growth in samples, PG (a rare aseptic, destructive inflammatory cutaneous condition) was suspected, and histology was compatible with this diagnosis. High-dose corticosteroids vastly improved his condition within 1 week, and after 2 months of decreasing-dose corticosteroid therapy, complete healing and normalization of the inflammatory syndrome were observed.

Discussion: Pyoderma gangrenosum should be considered if there is aseptic skin ulceration that is not controlled by antibiotic treatment. The first-line treatment for PG is high-dose systemic corticosteroids.

Keywords: Case report; Older adult; Pacemaker pocket infection; Pyoderma gangrenosum.

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Figures

Figure 1
Figure 1
Chest X-ray showing the location of the dual chamber pacemaker (Day 1).
Figure 2
Figure 2
Electrocardiogram showing Mobitz Type I atrioventricular block.
Figure 3
Figure 3
Screenshot of 24 h Holter monitoring showing diurnal 2:1 atrioventricular block.
Figure 4
Figure 4
Day 7 after implantation. A wide centrifugal extension necrotic ulcer, which had a well-defined limit and a purulent centre.
Figure 5
Figure 5
Day 8 operative sample. Histological examination, enlargement ×400, haematoxylin–eosin–saffron colouration. Dermal lesion by a polymorphic inflammatory infiltrate with a large predominance of neutrophils.
Figure 6
Figure 6
Day 16 (7 days after staring corticosteroid treatment). The lesion is less extensive; the inflammatory and necrotic aspects have disappeared; and there is budding of the wound that remains exudative.
Figure 7
Figure 7
Day 60 (2 months after starting corticosteroid therapy). Healed appearance with a hypertrophic centre.
None
See this image and copyright information in PMC

References

    1. Udo EO, Zuithoff NP, van Hemel NM, de Cock CC, Hendriks T, Doevendans PA, Moons K.. Incidence and predictors of short- and long-term complications in pacemaker therapy: the FOLLOWPACE study. Heart Rhythm 2012;9:728–735. - PubMed
    1. Selvapatt N, Barry J, Roberts PR.. Pyoderma gangrenosum complicating an implantable cardioverter defibrillator wound in a patient with ulcerative colitis. Europace 2009;11:1482–1482. - PubMed
    1. Kasper K, Manger B, Junger A, Reichert B, Sievers R, Herdtle S. [ Pyoderma gangrenosum following AICD implantation: differential diagnosis to necrotizing fasciitis]. Anaesthesist 2012;61:47–51. - PubMed
    1. Duncan A, Bharati A, Wu J, Currie P, White SI.. Pyoderma gangrenosum following pacemaker insertion. Clin Exp Dermatol 2009;34:444–445. - PubMed
    1. Kaur MR, Gach JE, Marshall H, Lewis HM.. Recurrent postoperative pyoderma gangrenosum complicating pacemaker insertion. J Eur Acad Dermatol Venereol 2006;20:466–467. - PubMed

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