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Chronic lymphocytic leukemia skin infiltration mimicking an ICD pocket infection: a case report
M Snorek1, A Bulava2,3,4, I Vonke5
1Department of Cardiology, Ceske Budejovice Hospital, Ceske Budejovice, Czech Republic.
Insights
A rare skin manifestation of chronic lymphocytic leukemia (CLL) occurred in a patient with an implantable cardioverter-defibrillator (ICD). Diagnosis required skin biopsy, not device removal, leading to resolution without chemotherapy.
Area of Science:
- Hematology
- Dermatology
- Oncology
Background:
- A case report detailing an unusual cutaneous manifestation of chronic lymphocytic leukemia (CLL).
- The patient had a history of CLL and an implantable cardioverter-defibrillator (ICD).
Observation:
- A 65-year-old male presented with a suspected ICD infection, exhibiting painless erythema and pruritus around the pulse generator pocket.
- Initial presentation mimicked infection, but atypical skin induration prompted further investigation.
- Microbiological examination was negative, but histological analysis revealed CD-5 positive B-cell CLL/SLL infiltration of the skin.
Findings:
- The skin induration was diagnosed as a cutaneous manifestation of CLL/SLL, not a device-related infection.
- The patient's skin condition resolved completely within two months without requiring chemotherapy or device extraction.
Implications:
- This case highlights the importance of considering cutaneous manifestations of hematological malignancies in patients with implanted devices.
- Exclusion of such manifestations through biopsy is crucial before device removal, especially in patients with a history of hematological disease.
- Complete removal of an ICD system carries significant risks, making accurate diagnosis of the underlying cause of skin changes paramount.
Background:
We are presenting a case report on an unreported and unusual cutaneous manifestation of chronic lymphocytic leukemia in a patient with an implantable cardioverter-defibrillator (ICD).
Case Presentation:
A 65-year-old man with a history of chronic lymphocytic leukemia (CLL), previously treated with chlorambucil, was referred in October 2013 for extraction of a single chamber ICD due to a suspected device-related infection in the pulse generator area (left-hand side of Fig. 1). The ICD system (Current VR, St. Jude Medical, USA) had been implanted in November 2009. The patient complained of painless erythema with pruritus in the pocket area. Inflammatory blood parameters were C-reactive protein 17.3 mg/L and leucocytes 29.0 × 109/L. Due to the atypical appearance of the pocket area we did not extract the device. Instead, we created an exploratory excision in the skin induration, which had been present for approximately 6 weeks, and conducted a microbiological and histological examination. All cultivation examinations were negative. However, we did histologically show skin infiltration by CD-5 positive low-grade B-cell chronic lymphocytic leukemia/small lymphocytic lymphoma (B-CLL/SLL). Re-initiation of chemotherapy was not necessary and the skin induration completely disappeared within 2 months (right-hand side of Fig. 1).
Conclusions:
Complete removal of an ICD system carries considerable risk. In patients with a history of hematological disease, it is crucial to exclude cutaneous manifestations of the disease prior to device removal.
