Allied Professionals (Non-physician submissions only) -> Teaching Case Reports D-PO05 - Poster Session V (ID 39) Poster

D-PO05-038 - Reticular Telangiectatic Erythema Masquerading As A Pocket Infection (ID 512)

 J.B. Shea: Nothing relevant to disclose.


Background: Reticular telangiectatic erythema is a benign cutaneous condition which manifests as localized areas of blanchable erythema and telangiectasia (or both).
Objective: Non-infectious cutaneous conditions can be mistaken for a pocket infection.
Results: DN is a 77-year-old male with senile cardiac amyloidosis, mod. MR, SND, pAF, stroke (9/18 on DOAC) and 2:1 AVB who underwent implantation of a dual chamber pacemaker in 2014 (SJM Endurity DR 2160) who presented in 4/19 with 2 weeks of left chest erythema. The chest erythema was asymptomatic with no systemic symptoms (fever, chills, myalgia, joint pain). He had a similar episode about 2 months prior, which resolved spontaneously. A full 12 system ROS was negative. A focused exam demonstrated a faint well demarcated erythematous patch of the left chest overlying the pacemaker pocket with prominent telangiectasias in the affected area (Figure 1). There was no detectable fluctuance and non-tender to palpation. Erythema was blanchable and homogenous. There was mild engorgement of the veins in the left arm. Afebrile with normal WBC. Dermatology was consulted.
Conclusion: The presenting erythema was asymptomatic with no objective evidence of pacemaker pocket infection (no fevers, leukocytosis, pain) nor allergy. There are descriptions in the literature of a similar erythema associated with pacemaker placement with resulting telangiectasias termed “Telangiectatic Pacemaker Erythema” (rosacea-like manifestation). This condition is benign and generally resolves spontaneously without the need to remove the pacemaker. EP practitioners should be aware of this phenomenon as a differential diagnosis. Figure 1