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.

Department of Cardiology Ceske Budejovice Hospital Ceske Budejovice Czech Republic

Department of Hematology Ceske Budejovice Hospital Ceske Budejovice Czech Republic

Faculty of Health and Social Sciences University of South Bohemia Ceske Budejovice Czech Republic

Faculty of Medicine and Dentistry Palacky University Olomouc Czech Republic

See more in PubMed

Polyzos KA, Konstantelias AA, Falagas ME. Risk factors for cardiac implantable electronic device infection: a systematic review and meta-analysis. Europace. 2015;17(5):767–77. doi: 10.1093/europace/euv053. PubMed DOI

Citerne O, Gomes S, Scanu P, Milliez P. Painful Eczema mimicking pocket infection in a patient with an ICD: a rare cause of skin allergy to nickel/cobalt alloy. Circulation. 2011;123(11):1241–2. doi: 10.1161/CIRCULATIONAHA.110.000547. PubMed DOI

De Mattia L, Brieda M, Dametto E. A carcinoma of the breast mimicking a pacemaker pocket infection. Europace. 2011;13(2):220. doi: 10.1093/europace/euq369. PubMed DOI