A Mysterious Recurrent Urticarial Rash and a Life-Altering Metal

Abstract

Allergic contact dermatitis is a common manifestation in individuals who have a contact hypersensitivity to nickel. Direct exposure to nickel triggers an adaptive immune response that mediates a localized inflammatory reaction of the skin, typically resulting in an erythematous and pruritic rash at the site of contact. We present a distinct case in which nickel was systemically introduced via a carotid stent into an individual with an unidentified allergy to nickel. This case emphasizes the potentially life-threatening risks associated with implantable hardware containing metals, such as nickel. Moreover, this case highlights the potential benefit that screening for metal allergies may have before surgically implanting permanent metal-based devices.

Keywords: allergic contact dermatitis (acd); carotid stent allergy; nickel hypersensitivity; nitinol; urticaria.

Figure 1. Images of the urticarial rash a) on the bilateral thighs with excoriations, b) on the right wrist with signs of dryness and lichenification, and c) on the anterior left knee with well-defined borders of erythema

Provided with permission by the patient.