Delayed Development of Foreign Body Granuloma from an Implanted Permanent Cardiac Pacemaker

Foreign body granuloma around implantable pulse generator for deep brain stimulation: Two case reports

We report two cases of granuloma that occurred around an implantable pulse generator (IPG) for deep brain stimulation. Both cases showed no signs of infection and disappeared after moving the IPG and removing the granulation. If a noninfectious mass is formed, the relocation of IPG may improve it.

Nickel and Skin: From Allergy to Autoimmunity

Introduction & Objectives:

Cutaneous and systemic reactions to various metal implants and medical devices have been well documented. The aim of this review was to focus on the probable common mechanisms of allergy and autoimmunity that may lead to similar clinical outcomes following the growing evidence in the literature of metal and nickel-related systemic, autoimmune or autoinflammatory disorders.

Methods:

Detailed search of the available electronic databases (PubMed-Medline) was conducted for review of the literature on that topic till the present moment.

Results:

Multiple reports on the immunological effects of metals including immunomodulation, allergy, or autoimmunity were identified. It was found that metals may act through immunosuppression, immunotoxicity, or as immune adjuvants thus provoking allergy and autoimmunity in susceptible individuals. Both external or internal exposure to metals was observed. Nickel has been identified as the most common sensitizer, and also the most studied one. The coexistence of both allergic and autoimmune symptoms, induced by nickel, has been published, suggesting the autoimmune potential of nickel compounds.

Conclusions:

Clinical experience and scientific literature together demonstrate that metals may play an important role in the development of autoimmune diseases. While metal implant allergies and complications are on the rise, they remain a diagnostic and therapeutic challenge. Elucidation of their possible mechanisms will contribute to the more successful and safer treatment of affected individuals.

Delayed granulomatous reaction and cutaneous fistula induced by retained electrodes from a cardiac pacemaker in a child

Permanent epicardial pacing wires are sometimes left in place and can lead to long-term complications. We report on a case of a granulomatous reaction with a cutaneous fistula secondary to the retained epicardial pacing wires in a child and highlight the relevance of sonography as an additional tool in the diagnosis and management of dermatologic conditions.

Pacing lead-induced granuloma in the atrium: a foreign body reaction to polyurethane

We described a case of an 82-year-old male who presented with a granuloma entrapping the polyurethane-coated pacing lead at the site of contact on the atrium. He had been paced for 8 years without symptoms or signs suggestive of an allergic reaction to the pacemaker system and died from thrombosis of the superior mesenteric artery and heart failure. A histological examination of the nodule showed an incidental granuloma with multinucleated giant cells. No granuloma was found in the heart or the lung.

Pressure cutaneous ulcer over a pacemaker successfully treated with left subcostal transplantation in an extremely thin patient

Implantation of a permanent cardiac pacemaker is becoming common with the increase in the elderly population. A cutaneous ulcer over the pacemaker is a rare complication. Most such cases previously reported demonstrate non-specific granuloma histologically, negative patch testing of materials used in the device, and no growth in the bacterial culture taken from the generator pocket. To date, the conventional treatments often result in a disappointing outcome. We describe an extremely thin 79-year-old Japanese male with a pressure cutaneous ulcer caused by the presence of a pacemaker device. This patient was referred to us with a 1-month history of repeated cutaneous ulcer and exposure of the cardiac pacemaker in the left pectoral area. Conservative treatment was not effective. Treatment with left subcostal implantation of a new pacemaker, which was not wrapped, and disposition of the electrodes in the subcutaneous tissue of the thorax was successful. Cutaneous manifestations have not recurred for 5 years. Considering the poor condition of the patient, subcostal translocation of the pacemaker was a simple and acceptable treatment for pressure cutaneous ulcer over the pacemaker.