[Erythema and swelling after im-plantation of a cardioverter defibrillator (ICD)].

HISTORY AND CLINICAL FINDINGS: We report the case of a 60-year-old man with localized erythema and edema, caused by an implanted cardioverter defibrillator (ICD).

EXAMINATION: An infection could be excluded by clinical examination, para clinical parameters and clinical chemistry. The histologic examination was indicative for hypersensitivity reaction. Patch test was negative but nickel sensitization was seen by lymphocyte transformation test and nickel could be measured in the pacemaker eluate.

TREATMENT AND COURSE: Based on the synopsis of negative patch testing, the hypersensitivity resembling histology and the corresponding in vitro analysis, the assumed cause for the dermatitis is a contact allergy to nickel as pacemaker component. After explantation, complete restitution of the skin could be observed.

CONCLUSIONS

Unusual skin reactions in patients with cardiac pacemakers are mostly referred to as "Pacemaker dermatitis". There are various potential causes: first, an infection needs to be excluded. Then, the possibility of both "pressure damage" caused by the pacemaker and the mostly symptom free "pacemaker erythema with telangiectasia" - synonym "post implantation erythema" - needs to be considered. When suspecting an incompatibility of the implant, further allergologic testing is required. Often, the removal of the pacemaker is inevitable.