Skin lesions over the pocket area that may mimic cardiac implantable electronic device infection: A case series

Abstract

Clinicians should be aware of rare conditions that mimic CIED infection. Incorrect diagnosis of these disorders may falsely lead to CIED extraction.

Malignancies masquerading as device pocket infections

“… 4 , 5 In addition, the clinical presentation of a device infection is often variable, ranging from subclinical device infections to a straightforward presentation with localized pocket swelling associated with fever and leukocytosis. A case series by Korantzopoulos and colleagues 6 reported 5 instances of skin lesions over cardiac device pockets that mimicked infection. The reported cases were found to be caused by localized cellulitis, herpes zoster, spontaneous hematoma, and irritant contact dermatitis.…”

A false alarm: Pacemaker pocket pseudo‐infection

“…Notably, we have reported a case series of patients with skin lesions that mimic pocket infection 4 . These conditions include local cellulitis after CIED implantation, spontaneous bruising, herpes zoster, contact dermatitis because of the prolonged postoperative application of povidone‐iodine 4 . However, most conditions that may be misinterpreted as CIED pocket infection are neoplastic (malignant tumors) 4 .…”

“… 4 However, most conditions that may be misinterpreted as CIED pocket infection are neoplastic (malignant tumors). 4 Moreover, titanium, nickel, or other pacemaker compounds may very rarely provoke allergic reactions including contact dermatitis. 4 Our patient suffered localized diffuse cellulitis without any obvious cause (local injury, sting, or bite).…”

“… 4 Moreover, titanium, nickel, or other pacemaker compounds may very rarely provoke allergic reactions including contact dermatitis. 4 Our patient suffered localized diffuse cellulitis without any obvious cause (local injury, sting, or bite). Clinicians should be aware of conditions mimicking CIED pocket infection.…”

Diagnosis and management of subcutaneous implantable cardioverter‐defibrillator infections based on process mapping

“…As etiologies other than CIED infection (Figure 2A, B) can cause inflammatory changes at the pocket and incision sites, 29 the diagnosis of S‐ICD infection, as with other CIED infections, can be difficult. Superficial skin and soft tissue infection (eg, cellulitis, stitch abscess) can occur, and non‐infectious syndromes due to allergic reactions to components of the device or tape, glue, or dressing used at an incision site, hematoma formation, and nonspecific postoperative changes are some of the conditions that have to be considered in the management of patients in the early postoperative period following S‐ICD placement.…”