Pocket Infection Leading to Complete Extrusion of an Implantable Cardiac Defibrillator

Pocket infection and complete device extrusion are uncommon but potentially life-threatening complications that present significant management challenges. Extrusion results from progressive skin erosion until the device exits the subcutaneous pocket, at which point the risk of bacterial contamination becomes high. Diagnosis of extrusion is based primarily on clinical examination, while the diagnosis of cardiac implantable electronic device (CIED) endocarditis relies on the modified Duke criteria in conjunction with multimodality imaging. Alongside echocardiography, 18F-FDG PET-CT is increasingly used for the diagnosis of endocarditis; it is particularly valuable when the diagnosis is uncertain and contributes to identifying potential portals of entry. Management depends on the extent of infection and requires bactericidal antibiotic therapy combined with complete device and lead extraction, followed by re-implantation of a new system when clinically appropriate. Early recognition of erosion signs before the device breaches the skin, along with rigorous measures to prevent pocket contamination and subsequent endocarditis, remains crucial to avoid severe complications.