PMID- 37932816
OWN - NLM
STAT- MEDLINE
DCOM- 20231108
LR  - 20231122
IS  - 1752-1947 (Electronic)
IS  - 1752-1947 (Linking)
VI  - 17
IP  - 1
DP  - 2023 Nov 7
TI  - Spinal cord stimulator explant caused by post-incisional cellulitis secondary to 
      Varicella Zoster Virus (shingles) infection: a case report.
PG  - 463
LID - 10.1186/s13256-023-04205-4 [doi]
LID - 463
AB  - INTRODUCTION: Spinal Cord Stimulation (SCS) is a well-established therapy for 
      refractory neuropathic pain, known for its safety and minimally-invasive nature. 
      However, complications, including surgical site infections (SSIs), can arise 
      post-implantation. SCS-related SSIs occur in 3.4% to 4.6% of cases within 90 days 
      post-implant, often requiring device removal and impacting pain management and 
      healthcare costs. The impulse generator, electrode implant site and 
      lumbar/thoracic surgical site are commonly affected, with local skin flora and 
      circulating organisms being the primary causes of infection. CASE PRESENTATION: 
      An 80-year-old Lebanese male with chronic neuropathic lower back and bilateral 
      leg pain, significantly impairing function, underwent prolonged hospitalizations 
      for COVID-19 infection and acute-on-chronic pain with Urinary Tract Infection 
      (UTI). Considering SCS as a therapeutic option, a successful trial led to 
      permanent implantation, resulting in improved pain severity and functional 
      capacity. However, three months later, the patient developed post-incisional 
      cellulitis and wound dehiscence secondary to Varicella Zoster Virus (shingles) 
      Infection directly over the Implantable Pulse Generator (IPG) incision line. 
      Despite antibiotic treatment, the infection progressed, necessitating SCS system 
      explantation. DISCUSSION: This represents the first reported case of VZV 
      infection causing wound dehiscence and SCS explantation post-implantation. 
      Contributing factors may include itching around the IPG site, facilitating deeper 
      tissue inoculation. Laboratory and imaging tests may not reliably detect SSIs, 
      and superficial infections may respond to antibiotics, while deep infections 
      typically require implant removal. Early identification and intervention are 
      vital to minimize complications. CONCLUSION: This unique case emphasizes the need 
      for heightened vigilance and monitoring in patients with viral infections near 
      medical devices. A standardized approach to assessing and managing SCS-related 
      infections is critical. Sharing such experiences contributes to improved 
      understanding and treatment of these rare incidents.
CI  - (c) 2023. BioMed Central Ltd., part of Springer Nature.
FAU - Mohabbati, Vahid
AU  - Mohabbati V
AD  - Sydney Pain Research Centre, Suite 213-215 Parkway SAN Clinic, 172 Fox Valley Rd 
      Wahroonga, Sydney, NSW, 2076, Australia. director@sydneypaincentre.com.
AD  - Sydney Pain Management Centre, Sydney, NSW, Australia. 
      director@sydneypaincentre.com.
FAU - Papan, Mohammadkazem
AU  - Papan M
AD  - Sydney Pain Research Centre, Suite 213-215 Parkway SAN Clinic, 172 Fox Valley Rd 
      Wahroonga, Sydney, NSW, 2076, Australia.
AD  - Sydney Pain Management Centre, Sydney, NSW, Australia.
LA  - eng
PT  - Case Reports
PT  - Journal Article
DEP - 20231107
PL  - England
TA  - J Med Case Rep
JT  - Journal of medical case reports
JID - 101293382
SB  - IM
MH  - Humans
MH  - Male
MH  - Aged, 80 and over
MH  - *Herpesvirus 3, Human
MH  - Cellulitis
MH  - Pain
MH  - *Herpes Zoster
MH  - Surgical Wound Infection
MH  - Spinal Cord
PMC - PMC10629098
OTO - NOTNLM
OT  - Case report
OT  - Implantable pulse generator (IPG)
OT  - Spinal cord stimulation (SCS)
OT  - Surgical site infection (SSI)
OT  - Varicella Zoster Virus (VZV)
COIS- The authors declare that there has been no conflict of interest in the 
      development or publication of this manuscript.
EDAT- 2023/11/07 06:45
MHDA- 2023/11/08 06:43
PMCR- 2023/11/07
CRDT- 2023/11/07 00:03
PHST- 2023/08/03 00:00 [received]
PHST- 2023/10/08 00:00 [accepted]
PHST- 2023/11/08 06:43 [medline]
PHST- 2023/11/07 06:45 [pubmed]
PHST- 2023/11/07 00:03 [entrez]
PHST- 2023/11/07 00:00 [pmc-release]
AID - 10.1186/s13256-023-04205-4 [pii]
AID - 4205 [pii]
AID - 10.1186/s13256-023-04205-4 [doi]
PST - epublish
SO  - J Med Case Rep. 2023 Nov 7;17(1):463. doi: 10.1186/s13256-023-04205-4.