SAN DIEGO — Two previous baclofen pumps had performed in the young patient without incident, Jonathan Dyer, M.D., reported at the annual meeting of the Society for Pediatric Dermatology.
The rash that developed after the implantation of the third pump was nontender and nonpruritic.
Histopathology showed peri-vascular inflammatory infiltrate of lymphocytes, histiocytes, and a few sparse neutrophils. The initial interpretation suggested resolving cellulitis.
“However, when we brought up the possibility of reticular telangiectatic erythema, we thought it was very consistent if not identical to the histopathology report of this condition in the literature,” said Dr. Dyer of the department of dermatology at the University of Missouri-Columbia.
He and his associate, Stacia Miles, M.D., patch-tested all of the pump's components; the tests came out negative. They also performed two 4-mm punch biopsies that were also negative.
However, a previous culture from the access port of the pump was positive for methicillin-resistant Staphylococcus epidermis (MRSE), so the boy was treated with 3 weeks of intravenous vancomycin. The rash gradually faded over a 6-week period.
Dr. Dyer said that reticular telangiectatic erythema was first described in 1981 overlying an implanted pacemaker.
“There have been about 14 cases described since,” he said. “It was thought to be innate to implantable cardioverter defibrillators or pacemakers. However, this year there was a description of the condition developing after implantation of a similar intrathecal pump” (Arch. Dermatol. 2005;141:106–7).
The exact cause of reticular telangiectatic erythema remains unclear. Possible etiologies suggested over the years include abnormal microcirculation in the area of the implanted pump, allergic contact dermatitis to pump components, irritation, electromagnetic radiation, and infection.
The favored hypothesis attributes the rash to alterations in the normal cutaneous anatomy induced by the implanted devices.
“Current thinking on reticular telangiectatic erythema is that it is not necessary to remove these pumps, but I think the issue of infection requires some consideration,” Dr. Dyer noted.
“In our case [the rash] did seem to get better after treatment for MRSE. While reticular telangiectatic erythema does not necessarily require removal of the device, I think you have to make sure that there's not some type of infection going on in these cases,” he reported.