We report an unusual case of an elderly man presenting with formation and rupture of an epidermal inclusion cyst at the level of an implantable cardiac defibrillator (ICD) pocket. The lesion appeared 2 years after ICD implantation, mimicking a decubitus or a pocket infection. Surgical revision showed no signs of infection of the pocket, but the pedunculated lesion was rooted in the subcutaneous tissue, whit an implant base external to the ICD pocket, which was removed and analyzed histologically, confirming the diagnosis of epidermal inclusion cyst. The pathophysiological mechanism of cyst formation is discussed. This case highlights the importance of an increased attention to lesions that mimic infections of a cardiac implantable electronic device pocket, thus preventing unnecessary complete removal of the device system.
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