Systemic hypersensitivity reaction (without cutaneous manifestations) to an implantable cardioverter-defibrillator

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.