Salma Haj Kheder1, Thomas Hummel2, Heike Majewski2, Rafael Jimènez3, Alexander Wutzler4. 1. Medizinische Klinik II Kardiologie, St. Josef Hospital, Universitätsklinikum der Ruhr-Universität Bochum, Gudrunstr. 56, 44791, Bochum, Deutschland. Salma.HajKheder@ruhr-uni-bochum.de. 2. Klinik für Gefäßchirurgie, St. Josef Hospital, Universitätsklinikum der Ruhr-Universität Bochum, Bochum, Deutschland. 3. Klinik für Dermatologie, Venerologie und Allergologie, St. Josef Hospital, Universitätsklinikum der Ruhr-Universität Bochum, Bochum, Deutschland. 4. Medizinische Klinik II Kardiologie, St. Josef Hospital, Universitätsklinikum der Ruhr-Universität Bochum, Gudrunstr. 56, 44791, Bochum, Deutschland.
Abstract
CASE REPORT: A 49-year-old man with Still's disease presented with a rash above his pacemaker scar. In 2012, there was a replacement of the generator in which the position was changed from subpectoral to subcutaneous. A revision operation was performed after the local finding became worse, turning from a granuloma to a macula. THERAPY: During surgery, a superficial position of the leads was revealed. Both leads and generator were removed with great effort from the granulation tissue. The new material was again implanted into a subpectoral position. The postoperative examination of the wound showed unremarkable signs of healing. CONCLUSION: After repositioning of the generator to a subcutaneous location, the skin was exposed to greater mechanical stress, which caused erythema and hypergranulation in a patient with Still's disease. A superficial position of a pacemaker should be avoided in patients affected by Still's disease.
CASE REPORT: A 49-year-old man with Still's disease presented with a rash above his pacemaker scar. In 2012, there was a replacement of the generator in which the position was changed from subpectoral to subcutaneous. A revision operation was performed after the local finding became worse, turning from a granuloma to a macula. THERAPY: During surgery, a superficial position of the leads was revealed. Both leads and generator were removed with great effort from the granulation tissue. The new material was again implanted into a subpectoral position. The postoperative examination of the wound showed unremarkable signs of healing. CONCLUSION: After repositioning of the generator to a subcutaneous location, the skin was exposed to greater mechanical stress, which caused erythema and hypergranulation in a patient with Still's disease. A superficial position of a pacemaker should be avoided in patients affected by Still's disease.