Severe Calcification in the Abdominal Pocket of an Implantable Pulse Generator (IPG) in a Patient on Long-Term Hemodialysis

Abstract

Introduction: Ectopic mineralization has been described in patients with end-stage renal failure managed with long-term hemodialysis. This study reports the first case of severe focal ectopic calcification in an implantable abdominal pulse generator pocket. The patient has a medical history of long-term hemodialysis and failed back surgery syndrome. The failed back surgery syndrome is treated with a spinal cord stimulator and an implantable pulse generator (IPG). Case report: Severe ectopic calcification of an implantable abdominal pulse generator pocket was observed in a 58-year-old female patient undergoing IPG relocation. The patient had a medical history of long-term hemodialysis for end-stage renal failure. She is also known with a spinal cord stimulator and an IPG for failed low back surgery syndrome. Microbiological study was negative and histopathological analysis confirmed the presence of focal calcifications in the implantable abdominal pulse generator pocket and on the IPG itself. Discussion: Extra-cellular matrix (ECM) calcification is highly prevalent in patients with end-stage renal failure. The exact mechanism remains unclear. Physiopathological disturbance in the calcium and phosphate homeostasis finally and a pro-inflammatory environment result in soft tissue. Conclusion: This is to our knowledge the first case reported in the literature of dystrophic severe focal ectopic calcification in the abdominal pocket of an implantable pulse generator (IPG) in a patient on long-term hemodialysis. Pain physicians should be aware of this phenomenon.