Pyoderma gangrenosum complicating a permanent pacemaker implantation: a case report and literature review. Issue 2 (12th March 2020)

• Record Type: Journal Article
• Authors: Frey, Pierre; Akret, Chrystelle; Irles, Didier; Dompnier, Antoine; Bing, Anne-Claire
• Editors: Cameli, Matteo; Niederseer, David; Cambronero-Cortinas, Esther; Cassar, Mark Philip; Green, Peregrine
• Is Part Of: European heart journal. Volume 4:Issue 2(2020)
• Page Start: 1
• Page End: 7
• Publication Date: 2020-03-12
• Subjects: Pyoderma gangrenosum -- Pacemaker pocket infection -- Older adult -- Case report; Cardiology -- Periodicals; Cardiology -- Case studies -- Periodicals; Heart -- Diseases -- Periodicals; Heart -- Diseases -- Case studies -- Periodicals; 616.12
• DOI: 10.1093/ehjcr/ytaa049
• Languages: English
• ISSNs: 2514-2119

Abstract

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.