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Case Reports
. 2023 Nov 7;17(1):463.
doi: 10.1186/s13256-023-04205-4.

Spinal cord stimulator explant caused by post-incisional cellulitis secondary to Varicella Zoster Virus (shingles) infection: a case report

Vahid Mohabbati  1   2 , Mohammadkazem Papan  3   4
Affiliations
Case Reports

Spinal cord stimulator explant caused by post-incisional cellulitis secondary to Varicella Zoster Virus (shingles) infection: a case report

Vahid Mohabbati et al. J Med Case Rep. .

Abstract

Introduction: Spinal Cord Stimulation (SCS) is a well-established therapy for refractory neuropathic pain, known for its safety and minimally-invasive nature. However, complications, including surgical site infections (SSIs), can arise post-implantation. SCS-related SSIs occur in 3.4% to 4.6% of cases within 90 days post-implant, often requiring device removal and impacting pain management and healthcare costs. The impulse generator, electrode implant site and lumbar/thoracic surgical site are commonly affected, with local skin flora and circulating organisms being the primary causes of infection.

Case presentation: An 80-year-old Lebanese male with chronic neuropathic lower back and bilateral leg pain, significantly impairing function, underwent prolonged hospitalizations for COVID-19 infection and acute-on-chronic pain with Urinary Tract Infection (UTI). Considering SCS as a therapeutic option, a successful trial led to permanent implantation, resulting in improved pain severity and functional capacity. However, three months later, the patient developed post-incisional cellulitis and wound dehiscence secondary to Varicella Zoster Virus (shingles) Infection directly over the Implantable Pulse Generator (IPG) incision line. Despite antibiotic treatment, the infection progressed, necessitating SCS system explantation.

Discussion: This represents the first reported case of VZV infection causing wound dehiscence and SCS explantation post-implantation. Contributing factors may include itching around the IPG site, facilitating deeper tissue inoculation. Laboratory and imaging tests may not reliably detect SSIs, and superficial infections may respond to antibiotics, while deep infections typically require implant removal. Early identification and intervention are vital to minimize complications.

Conclusion: This unique case emphasizes the need for heightened vigilance and monitoring in patients with viral infections near medical devices. A standardized approach to assessing and managing SCS-related infections is critical. Sharing such experiences contributes to improved understanding and treatment of these rare incidents.

Keywords: Case report; Implantable pulse generator (IPG); Spinal cord stimulation (SCS); Surgical site infection (SSI); Varicella Zoster Virus (VZV).

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Conflict of interest statement

The authors declare that there has been no conflict of interest in the development or publication of this manuscript.

Figures

Fig. 1
Fig. 1
Infection in the abdominal wall after three months of SCS implantation. Shingles, also known as herpes zoster, is a painful rash caused by the varicella-zoster virus, as it can be seen in the image near the implantation. SCS spinal cord stimulation
Fig. 2
Fig. 2
Infection in the abdominal wall after three months of SCS implantation. Shingles, also known as herpes zoster, is a painful rash caused by the varicella-zoster virus, as it can be seen in the image near the implantation. SCS spinal cord stimulation
Fig. 3
Fig. 3
Infection in the abdominal wall after three months of SCS implantation. Shingles, also known as herpes zoster, is a painful rash caused by the varicella-zoster virus, as it can be seen in the image near the implantation. SCS spinal cord stimulation
Fig. 4
Fig. 4
A summary of the clinical course of all follow-up visits
See this image and copyright information in PMC

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