Pediatric Implant of a Gold-Coated Defibrillator due to Persistent Metal Hypersensitivity: Case Report

A 9-year-old boy presented with repeated exteriorization of four implantable cardioverter-defibrillators (ICDs), despite changes in implantation site and the use of antimicrobial or polymeric envelopes. The initial device was placed following an episode of ventricular fibrillation, with imaging revealing non-obstructive hypertrophic cardiomyopathy. Over subsequent procedures, he developed hypertrophic incisional scarring and granulomatous inflammation. Titanium hypersensitivity was confirmed via dermal testing, though all wound and blood cultures remained negative. After partial exteriorization of a fifth device, a gold-coated ICD was implanted, with improved wound healing. This case underscores the need to consider allergic reactions to device materials when managing recurrent pocket complications.