Chronic lymphocytic leukemia skin infiltration mimicking an ICD pocket infection: a case report.
We are presenting a case report on an unreported and unusual cutaneous manifestation of chronic lymphocytic leukemia in a patient with an implantable cardioverter-defibrillator (ICD).



A 65-year-old man with a history of chronic lymphocytic leukemia (CLL), previously treated with chlorambucil, was referred in October 2013 for extraction of a single chamber ICD due to a suspected device-related infection in the pulse generator area (left-hand side of Fig. 1). The ICD system (Current VR, St. Jude Medical, USA) had been implanted in November 2009. The patient complained of painless erythema with pruritus in the pocket area. Inflammatory blood parameters were C-reactive protein 17.3 mg/L and leucocytes 29.0 × 109/L. Due to the atypical appearance of the pocket area we did not extract the device. Instead, we created an exploratory excision in the skin induration, which had been present for approximately 6 weeks, and conducted a microbiological and histological examination. All cultivation examinations were negative. However, we did histologically show skin infiltration by CD-5 positive low-grade B-cell chronic lymphocytic leukemia/small lymphocytic lymphoma (B-CLL/SLL). Re-initiation of chemotherapy was not necessary and the skin induration completely disappeared within 2 months (right-hand side of Fig. 1).



Complete removal of an ICD system carries considerable risk. In patients with a history of hematological disease, it is crucial to exclude cutaneous manifestations of the disease prior to device removal.
Department of Cardiology, Ceske Budejovice Hospital, Ceske Budejovice, Czech Republic.
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Snorek
Department of Cardiology, Ceske Budejovice Hospital, Ceske Budejovice, Czech Republic. alanbulava@seznam.cz.|Faculty of Health and Social Sciences, University of South Bohemia, Ceske Budejovice, Czech Republic. alanbulava@seznam.cz.|Faculty of Medicine and Dentistry, Palacky University, Olomouc, Czech Republic. alanbulava@seznam.cz.
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A
Bulava
Department of Hematology, Ceske Budejovice Hospital, Ceske Budejovice, Czech Republic.
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Vonke
D000368:Aged; D001706:Biopsy; D017147:Defibrillators, Implantable; D003937:Diagnosis, Differential; D004554:Electric Countershock / Q000295:instrumentation*; D006801:Humans; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology; D017254:Leukemic Infiltration; D008297:Male; D011237:Predictive Value of Tests; D019919:Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D016459:Prosthesis-Related Infections / Q000175:diagnosis*; D012867:Skin / Q000473:pathology*
Chronic lymphocytic leukemia; Implantable cardioverter-defibrillator; Pocket infection