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Case Reports
. 2025 Jul 4;11(9):948-952.
doi: 10.1016/j.hrcr.2025.06.029. eCollection 2025 Sep.

Recurrent rash over a cardiac implantable electronic device: A rare case of antibacterial envelope hypersensitivity

José Antonio Fernández-Sánchez  1   2 , Babken Asatryan  1 , Jennifer Roper  3 , José Madrazo  1 , Charles J Love  1 , Antoine E Azar  3 , Andreas S Barth  1
Affiliations
Case Reports

Recurrent rash over a cardiac implantable electronic device: A rare case of antibacterial envelope hypersensitivity

José Antonio Fernández-Sánchez et al. HeartRhythm Case Rep. .
No abstract available

Keywords: Cardiac device; Envelope; Extravascular; Hypersensitivity; ICD; Infection; Rash; TYRX.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
A: Right arm with pruritic rash caused by an allergic reaction. B–C: Recurrent localized rash above the EV-ICD pocket resembling “bug bites.” The incision shows a well-healed scar. EV-ICD = extravascular implantable cardioverter-defibrillator.
Figure 2
Figure 2
Progression of ALT levels (U/L) over several months, showing declines after treatment with systemic corticosteroids and loratadine. Topical steroids were also used intermittently as needed. ALT = alanine aminotransferase.
Figure 3
Figure 3
A–B: Patch testing (NAC-80 North American comprehensive series, 2024 edition) with negative results. C: Exposure to intradermal injection of rifampicin (“R”) (positive) and minocycline (“M”) (negative).
See this image and copyright information in PMC

References

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    1. Baddour L.M., Esquer Garrigos Z., Rizwan Sohail M., et al. Update on cardiovascular implantable electronic device infections and their prevention, diagnosis, and management: a scientific statement from the American Heart Association: endorsed by the International Society for cardiovascular infectious diseases. Circulation. 2024;149:e201–e216. - PubMed
    1. Boriani G., Kennergren C., Tarakji K.G., et al. Cost-effectiveness analyses of an absorbable antibacterial envelope for use in patients at increased risk of cardiac implantable electronic device infection in Germany, Italy, and England. Value Health. 2021;24:930–938. - PubMed
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    1. Chaudhry U., Borgquist R., Smith J.G., Mörtsell D. Efficacy of the antibacterial envelope to prevent cardiac implantable electronic device infection in a high-risk population. Europace. 2022;24:1973–1980. - PubMed

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