Allied Professionals (Non-physician submissions only) -> Teaching Case Reports D-AB18 - Quirks and Quarks from the EP Lab (ID 38) Abstract

D-AB18-02 - Identification Of Cutaneous B-cell Lymphoma In Presumed CIED Pocket Infection (ID 1447)

Disclosure
 T. Moseley: Nothing relevant to disclose.

Abstract

Background: Infectious complications following cardiac implantable electronic device (CIED) implantation are associated with significant mortality. Rare cases of malignancy mimicking a pocket infection have been described. We present a case of large B-Cell Lymphoma initially thought to be a CIED pocket infection.
Results: A 90-year-old female with complete heart block s/p pacemaker in 2000 s/p Bi-V ICD upgrade for HFrEF, ESRD, HTN, CVA, RA, DM and remote lymphoma presented with progressive device pocket swelling and erythema with no CIED interventions since 2014. The device site was swollen and tender to touch (Fig 1A). She had no systemic signs or symptoms of infection.
She underwent pulse generator removal, debridement and capsulectomy. Operative report noted “intense inflammatory reaction” as well as necrosis but no purulence. Wound care was performed for 3 weeks. An area of induration and discoloration persisted and noted to increase in size. CT showed persistent fluid collection with no drainable abscess noted on ultrasound. She completed 3 weeks of broad spectrum antibiotics and had negative OR cultures as well as negative blood cultures. The area continued to enlarge and did not respond to silver nitrate, eventually breaking through the epidermis and exposing vascularized tissue (Fig 1B). Pocket exploration, debridement and primary wound closure was performed. Pathology was consistent with large B-Cell Lymphoma.
Conclusion: Complete removal of an ICD system carries considerable risk. In patients with a history of hematological disease, it is important to identify and exclude cutaneous manifestations of the disease prior to device system removal.
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