Systemic Hypersensitivity Reaction (Without Cutaneous Manifestations) to an Implantable Cardioverter-Defibrillator

Israel D. Andrews; Pamela Scheinman

Disclosures

Dermatitis. 2011;22(3):161-164. 

In This Article

Abstract and Introduction

Abstract

Implantable cardiac devices play a significant role in decreasing the morbidity and mortality in patients with cardiovascular disease. Tissue-device interactions leading to systemic hypersensitivity are rarely reported or are perhaps misdiagnosed as infectious in origin. We report the case of a 51-year-old female who underwent placement of an implantable cardiac defibrillator (ICD) and a biventricular pacemaker and who immediately postoperatively experienced sepsislike symptoms without any identifiable causative pathogens and without any dermatitis. Patch testing revealed an extreme reaction to cobalt confirmed as present in the defibrillator. Removal of the ICD led to the complete resolution of her symptoms. Patch testing helped guide the construction of a gold-coated ICD, which was implanted in the patient. The patient has remained symptom free after implantation of this gilded ICD.

Introduction

Skin Involvement as a sign of an allergic reaction to an implantable cardiac defibrillator (ICD) or pacemaker typically manifests as localized erythema with dermatitis on or near the site of implantation. A review of the literature finds at least 30 reported cases of allergy to an ICD or pacemaker component manifesting with localized skin findings.[1] However, no case report has detailed noninfectious systemic reactions without skin findings to pacemaker or ICD components. Allergens reported as causing ICD-related dermatitis include titanium, silicone, cobalt, epoxy, polyurethane, and thiuram mix.[1] We report the case of a patient who developed a systemic sepsislike reaction without skin manifestations after the placement of an ICD and a biventricular pacemaker. Patch testing showed that the patient had a contact allergy to metals present in her ICD. She experienced a complete resolution of symptoms with the removal of the allergenic ICD and has remained symptom free after the placement of a new ICD containing none of her allergens.

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