Reticulated telangiectatic erythema (RTE) is a rare skin complication of unknown etiology, which develops following the implantation of metal devices in the subcutaneous tissues and could eventually lead to extrusion of the device. The infrequency with which it is encountered makes RTE a formidable diagnostic challenge, which may lead to unnecessary diagnostic procedures. This is of even greater significance given the trend of increasing device implantations. A 51-year-old man with a history of ischemic cardiomyopathy with severe left ventricular systolic dysfunction (ejection fraction 10-15%), who is status post-automatic implantable cardioverter defibrillator (AICD) placement, presented with redness, itching, and swelling of the AICD pocket, which developed shortly after implantation and had recently progressed. No other symptoms were reported. Physical examination was unremarkable except for a 5 × 6 cm area of erythematous, tender, and nonfluctuant swelling around his AICD. A needle aspiration of the swollen AICD pocket revealed 5 mL of blood-tinged, nonpurulent fluid. Gram stain and cultures were negative. Empiric outpatient antibiotics therapy was initiated, without any clinical improvement. He was then referred for a dermatology evaluation, which led to the diagnosis of RTE due to AICD gravitation, with the recommendation to change the location of the device if the erythema persists. A follow-up examination, a few weeks later, showed that the AICD generator has moved to a more superficial position. Due to the high risk of extrusion of the AICD, the patient had a subpectoral repositioning of his device through his previous skin incision. He was discharged the next day on prophylactic antibiotic therapy and has continued to do well without any recurrence. RTE is a rare phenomenon of unknown pathogenesis, which could lead to the ulceration and possible extrusion of an implanted device. The hallmark of the disease is local erythema and the absence of other markers of inflammation. The diagnosis is clinical, and tests such as skin patch tests or biopsies are not considered necessary. Although it is sometime self-limiting, treatment may involve relocation of the device. Repeated episodes may warrant discontinuation of device therapy. Physicians should be familiar with this clinical entity to avoid unnecessary diagnostic procedures or removal of AICDs.
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