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| Author, year | Patient characteristics | Onset | Presentation | Outcome |
|
| Lo et al. [3], 2002 | 85 F with monoclonal gammopathy and polymyalgia rheumatica | Not discussed | Ulcer with erythematous border on the left anterior chest | Initial treatment as infection led to pacemaker extraction; healing occurred with systemic corticosteroids. |
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| Gebska et al. [4], 2005 | 71 M | Recurrent skin lesions at the site of pacemaker implantation in the upper thorax | Not discussed | Steroid therapy resulted in improvement and abdominal implant was considered instead. |
|
| Kaur et al. [5], 2006 | 71 F with syncope | 3 weeks following pacemaker implantation | Red, indurated, and partially open ulcer at the site of implant | Patient was started on antibiotics and pacemaker was removed. Two more trials of pacemaker insertion were done with continued ulceration in both cases. Topical steroids were ineffective. Prednisolone (20 mg/day) for 10 days resulted in improvement. Remained well-controlled on cyclosporine for two months without recurrence. |
|
| Cosio et al. [6], 2006 | 70 F with monoclonal gammopathy, diabetes, and 2 : 1 atrioventricular block | Postoperative day 7 | Painful, necrotic lesion at the implant site | Prednisone (60 mg daily) led to healing within 3 weeks. Patient developed concomitant heart failure and nephrotic syndrome, which led to death 1 month following admission. |
|
| Duncan et al. [7], 2009 | 64 M with second-degree heart block | 15 months following pacemaker implantation | Unrelated trauma to the implant site led to cystic swelling and subsequent ulceration | Pacemaker broke down following ulceration. Antibiotics failed to benefit. Prednisolone (60 mg/day) led to improvement. This was followed by recurrence after steroids taper. Restarting prednisolone with cyclosporine (3 mg/kg) led to complete healing. Patient remained controlled on cyclosporine. |
|
| Marzak et al. [8], 2019 | 72 M with 2 : 1 atrioventricular block | Postoperative day 4 | Inflammatory, infiltrative, necrotic ulcer at the implant site | Initial treatment with antibiotics led to continued necrosis; local healing occurred with systemic corticosteroids. On postoperative day 45, patient developed septic shock secondary to infection of prior PG lesion. Removal and reimplantation of new pacemaker were done. IV infliximab (5 mg/kg), colchicine (1 mg/day), corticosteroids (1 mg/kg), and antibiotics were prophylactically given. One-year follow-up was uneventful. |
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| Ayoubi et al., 2019 | 76 M with rheumatoid arthritis | Postoperative day 4 | Pain at the incision site, coupled with erythema and purulent drainage | Initial treatment with antibiotics was ineffective. Swabs of purulent material revealed negative cultures for bacterial growth. Systemic prednisone (1 mg/kg) resulted in complete healing in 3 weeks. Steroid maintenance allowed for reimplantation of new pacemaker without complications. |
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