Systemic Allergic Reaction to a Spinal Cord Stimulator Trial: A Case Report

Spinal cord stimulation (SCS) is commonly used for the management of chronic pain conditions, such as intractable axial and radicular back pain, complex regional pain syndrome, and painful peripheral vascular disease. Patients have had adverse complications with SCS trials and permanent implants. Cases of contact dermatitis from SCS devices have been reported, but a systemic allergic reaction to an SCS trial has not yet been published to date.

A 52-year-old woman with complex regional pain syndrome type II and a history of a presumed infectious reaction to a previous SCS trial 8 years prior presented with chronic right L5, S1 radicular pain. Having failed conservative measures, she underwent a repeat SCS trial. The lead was placed at the T8 vertebral body, migrated several days later to the T9 vertebral body, and was subsequently adjusted back to T8 under fluoroscopic guidance. The patient reported improvement in her back and leg pain. Three days later, she presented to the emergency department with subjective fever, headache, rigors, chills, diaphoresis, nausea, vomiting, and diarrhea. The lead was removed, and the patient's acute symptoms resolved within 48 hours.

Systemic allergic reactions to SCS can be significant and lead to device removal despite improvement in pain symptoms. Further case reports and studies are needed to elucidate the risks associated with SCS placement, such as allergic reaction, infection, and neurologic injury.