Metal Hypersensitivity After Cardiovascular Device Implantation Presenting With Refractory Urticaria and Angioedema

Systemic hypersensitivity after metallic cardiovascular device implantation is uncommon and may mimic spontaneous urticaria or bradykinin-mediated angioedema.

A 40-year-old woman underwent implantable loop-recorder placement followed 4 days later by percutaneous closure of a secundum atrial septal defect with a 14-mm nitinol occluder. Approximately 5 months later, she developed recurrent generalized pruritic urticaria with facial, lip, and tongue angioedema despite corticosteroids, antihistamines, H2 blockade, montelukast, and epinephrine. Complement component 4 and serial C1-esterase inhibitor testing did not support C1-inhibitor deficiency. Patch testing documented nickel and chromium sensitization. Both implanted devices were surgically removed with primary septal repair.

The chronology, refractory phenotype, documented metal sensitization, and postexplantation nonrecurrence support an implant-associated hypersensitivity syndrome, although attribution to either device individually is not possible.

Consider implanted-metal hypersensitivity in otherwise unexplained refractory urticaria and angioedema after cardiovascular device implantation.