An 80-year-old man had a secondary prevention defibrillator in place for
treatment of sustained ventricular tachycardia. After a generator
replacement several years later, he developed a series of apparent pulse
generator infections requiring extraction. Each purulent appearing
pocket eruption was culture negative. Eventually, he was diagnosed with
a delayed hypersensitivity reaction to triclosan, an antibacterial that
is commonly impregnated in surgical sutures. The evaluation for this is
difficult and can be misleading. This entity should be considered in the
differential diagnosis of patients with culture negative CIED
infections.