Graft-versus-host disease: A rare complication of device implantation

Case description We present a 55-year-old Caucasian man with ischemic cardiomyopathy and acute myeloid leukemia, for which he had undergone successful stem cell transplantation but which was later complicated by chronic GVHD. He was hospitalized 2 months after dual-chamber ICD implantation for concerns of pocket infection and treated with intravenous antibiotics. His initial case of acute GVHD was several months after his stem cell transplant and was localized to the skin on his hands. This was successfully treated with cyclosporine and triamcinolone cream. He subsequently experienced chronic GVHD over 50% of his body surface, proven by skin biopsy, with sicca syndrome and was started on systemic steroids, which resolved his symptoms. He was seen for an evaluation of an inflammatory skin lesion overlying his ICD (Figure 1). There had not been a definite diagnosis as to the cause of this erythema. The skin lesion was an approximately 3 3-cm atrophic patch directly overlying the ICD device module with mild peripheral erythema, prominent telangiectasias, and central honeycolored crusting. There was no drainage, discharge, dermal induration, or scale. The patient had negative cultures, leukocytosis of unknown etiology, and no fevers or chills, and was started on vancomycin and cefepime for a possible infection of the site. A transesophageal echocardiogram was