• Images in cardiology

Pyoderma gangrenosum (PG) is a rare painful ulcerative cutaneous disease of unknown aetiology. An underlying systemic disorder is associated in up to 50% of cases. We present a case of PG which developed after permanent pacemaker implantation in an 85 year old woman with a background history of monoclonal gammopathy and polymyalgia rheumatica. This was initially treated as a severely infected pacemaker site, which led to extraction of her pacemaker system. Her wound only started to heal after she was treated with systemic steroids.

PG has been reported following various surgeries but to the best of our knowledge none has been reported following permanent pacemaker implant. Such diagnosis should be born in mind as it may avoid unnecessary pacemaker system extraction, a lesson we have now learned.