We are presenting a 71-years old male patient with chronic skin lesions that appeared at multiple site of pacemaker implantations in the upper thorax. In spite of many treatment trials, no significant improvements were accomplished. Expanded dermatological tests including serial histopathological examinations were necessarily performed. Based on test results and clinical presentations, the diagnosis of pyoderma gangrenosum was made. Immediate steroid therapy allowed dramatic improvement of the chronic inflammatory condition. The patient is still undergoing a close dermatological and cardiological follow-up. Replacement of the pacemaker into the abdomen is currently being considered.