title: [Exceptional pacemaker complication in Still's disease].
abstract: METHODS
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Medizinische Klinik II Kardiologie, St. Josef Hospital, Universitätsklinikum der Ruhr-Universität Bochum, Gudrunstr. 56, 44791, Bochum, Deutschland. Salma.HajKheder@ruhr-uni-bochum.de.
authors.forename: Salma
authors.initials: S
authors.lastname: Haj Kheder
authors.affiliation: Klinik für Gefäßchirurgie, St. Josef Hospital, Universitätsklinikum der Ruhr-Universität Bochum, Bochum, Deutschland.
authors.forename: Thomas
authors.initials: T
authors.lastname: Hummel
authors.affiliation: Klinik für Gefäßchirurgie, St. Josef Hospital, Universitätsklinikum der Ruhr-Universität Bochum, Bochum, Deutschland.
authors.forename: Heike
authors.initials: H
authors.lastname: Majewski
authors.affiliation: Klinik für Dermatologie, Venerologie und Allergologie, St. Josef Hospital, Universitätsklinikum der Ruhr-Universität Bochum, Bochum, Deutschland.
authors.forename: Rafael
authors.initials: R
authors.lastname: Jimènez
authors.affiliation: Medizinische Klinik II Kardiologie, St. Josef Hospital, Universitätsklinikum der Ruhr-Universität Bochum, Gudrunstr. 56, 44791, Bochum, Deutschland.
authors.forename: Alexander
authors.initials: A
authors.lastname: Wutzler
mesh_terms: D002921:Cicatrix / Q000150:complications / Q000601:surgery; D004567:Electrodes, Implanted / Q000009:adverse effects; D004890:Erythema / Q000209:etiology* / Q000601:surgery; D015745:Granuloma, Foreign-Body / Q000209:etiology* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial / Q000009:adverse effects*; D012086:Reoperation; D016706:Still's Disease, Adult-Onset / Q000150:complications*
keywords: Erythema; Foreign body granuloma; Isomorphic phenomena; Pacemaker complication; Still’s disease