Author/Authors :
Ayoubi, Noura Morsani College of Medicine - University of South Florida, Tampa, Florida, USA , Javeed, Zaydi Morsani College of Medicine - University of South Florida, Tampa, Florida, USA , Cutro, Raymond Department of Cardiology - James A. Haley Veterans’ Hospital, Tampa, Florida, USA , Baldwin, Brooke T. Department of Dermatology - James A. Haley Veterans’ Hospital, Tampa, Florida, USA
Abstract :
Pyoderma gangrenosum (PG) is a rare neutrophilic dermatosis characterized by noninfectious, inflammatory, ulcerating
lesions. Pathergy can be seen in these patients, whereby minor trauma or surgery can result in the development of PG
ulcerations. Here, we present a case of PG following pacemaker implantation. A 76-year-old male with a history of
rheumatoid arthritis presented to the cardiology team with symptomatic bradycardia. Indications for implantation were
met, and the procedure was performed in a routine fashion. The patient returned to clinic for follow-up four days later,
complaining of pain at the incision site, coupled with erythema and purulent drainage. Consultations with an infectious
disease specialist and a dermatologist were requested, and the diagnosis of pyoderma gangrenosum was considered. The
patient underwent device removal and received systemic corticosteroids at a dose of 1 mg/kg prednisone with complete
lesion healing in 3 weeks. While being maintained on steroids, the patient underwent reimplantation of a new pacemaker
on the contralateral side without complication and had a normal postoperative course. We present this case report, along
with the review of literature, in order to highlight the multidisciplinary approach to management, which requires
dermatologic treatment in order to achieve pacemaker success.
