A Systemic Allergic Reaction to Nickel Requiring Explantation of a Septal Occluder Device.

Abstract

To the Editor: Nitinol is an alloy of nickel and titanium used in the Amplatzer (AGA Medical Corp/St Jude Medical, Inc, Golden Valley, MN) septal occluder device (SOD) used in interventional cardiology for percutaneous closure of defects such as interauricular communication (IAC). Prevalence of nickel hypersensitivity is estimated approximately 10% in the general adult population. The SOD leaflet states that allergic reactions are possible in nickel-allergic patients, but nickel allergy does not appear in the contraindications to implantation. We report the case of a patient with a known nickel allergy who developed a systemic allergic reaction 5 days after the implantation of an SOD. A 43-year-old female patient had a stroke in July 2014 that led to IAC discovery. She had a history of reaction to costume jewelry with nickel allergy confirmed by patch testing. The IAC was treated with an Amplatzer SOD. Five days after implantation, she experienced intense, nonradiating, burning, permanent left precordial pain. Echocardiography was normal. Many other symptoms appeared in the following months, including asthenia, fold eczema, nausea, arthralgia, tinnitus, and pruritus. Prescribed medications including systemic steroids were ineffective. Exhaustive explorations remained normal. In July 2017, patch testing was performed with the European baseline series andmetal series, which found strong allergic reactions of 3+ to nickel at day 3. Patch testing led to a flare-up with reoccurrence of fold eczema lesions. In December 2017, the SOD was removed, and the IAC was treated surgically. During the procedure, the surgeon notified that the SOD was only partially covered with fibrin (Fig. 1). Patch testing performed with the SOD showed macular erythema. Three months after surgery, left chest pain and arthralgia had disappeared, and other symptoms had improved. Ten months after the surgery, all symptoms had disappeared and did not recur at the last follow-up at 2 years.