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

Pierre Frey1, Chrystelle Akret1, Didier Irles1

  • 1Department of Cardiology, Centre Hospitalier Annecy Genevois, 1 Avenue de l'Hôpital, 74370 Metz-Tessy, France.

European Heart Journal. Case Reports
|May 1, 2020
PubMed
Abstract

Insights

Pyoderma gangrenosum (PG) is a rare complication after cardiac device implantation. Prompt diagnosis and high-dose corticosteroids are crucial for managing this aseptic skin ulceration.

Area of Science:

  • Cardiology
  • Dermatology
  • Medical Case Reports

Background:

  • Pocket complications are frequent following cardiac implantable electronic device (CIED) implantation.
  • Pyoderma gangrenosum (PG) is an uncommon but severe complication that can arise post-CIED surgery.

Purpose of the Study:

  • To report a rare case of pyoderma gangrenosum (PG) complicating permanent pacemaker implantation.
  • To conduct the first literature review of 10 previously published cases of PG following CIED implantation.

Main Methods:

  • A case of a 93-year-old male patient who developed a necrotic wound post-pacemaker implantation is presented.
  • Diagnostic workup included clinical evaluation, wound sampling, histology, and exclusion of infectious etiology.
  • Treatment involved pacemaker removal, antibiotics, and high-dose systemic corticosteroids.

Main Results:

  • The patient presented with wound pain, bleeding, fever, and a necrotic ulcer 7 days after pacemaker implantation.
  • Histology confirmed PG, and cultures showed no bacterial growth, ruling out infection.
  • High-dose corticosteroids led to rapid improvement within a week, with complete healing and normalized inflammatory markers after two months.

Conclusions:

  • Pyoderma gangrenosum (PG) must be considered in cases of aseptic skin ulceration unresponsive to antibiotics after CIED procedures.
  • High-dose systemic corticosteroids are the recommended first-line treatment for PG.
Keywords:
Case reportOlder adultPacemaker pocket infectionPyoderma gangrenosum

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