case_images: PMC4785634_01
case_images: A: Right-sided CIED cardiac implantable electrical device (CIED) site. B: Chronically discharging and poorly healing wound at site of recent extraction of a CIED. C and D: Photomicrographs of skin biopsy with suppurative granulomatous inflammation and foci of necrosis. (H & E staining; D x40, E x100). E: Following prolonged treatment with doxycycline and clarithromycin, the discharge stopped and the irritation at the CIED extraction site settled.
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case_images: PMC4785634_01_gr1.jpg
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case_images: A week after the device was extracted, he underwent reimplantation with a right-sided CRT-D (Figure 1A) and was subsequently discharged clinically well. Following his discharge from the hospital, the patient noted poor skin healing around the site of the CIED extraction (Figure 1B). The skin-punch biopsy demonstrated marked suppurative granulomatous inflammation (Figures 1C and 1D). After 4 weeks off treatment, the discharge from the previous CIED site stopped, and there were no further episodes of tenderness or swelling (Figure 1E).