Dermite de contact systémique au nickel induite par un cathéter veineux

Abstract

Systemic contact dermatitis is a form of delayed hypersensitivity reaction seen after systemic administration of a hapten in a subject previously sensitised via the cutaneous route. There have been few reports of this condition with nickel. In this paper, we describe four cases ascribable to the presence of nickel in a peripheral venous catheter. We reviewed the dossiers of four women developing pruriginous exanthema several hours after infusion. The same type of catheter (Optiva) was used in all cases. Epicutaneous tests were performed in all four patients, as well as a challenge test comprising a serum glucose infusion given via the incriminated catheter. Testing for the presence of nickel in the catheter was performed by means of a spot-test. Quantitative nickel assays were performed in vitro using inductively coupled plasma mass spectrometry on the glucose solution infusion kits with eight sample catheters and a negative control kit. The eruptions comprised maculopapular lesions, in some cases vesicular or bullous, arranged symmetrically around the tops of the limbs, the trunk and skin folds, with involvement of the infused forearm in most cases. Two of the four patients had previously presented a number of similar episodes. All four patients exhibited frankly positive test results for nickel and the role of the Optiva) catheter was demonstrated in all four patients by means of a challenge test. The presence of nickel in the catheter was demonstrated by a positive spot-test and was confirmed by quantitative assay demonstrating variations in nickel release for the different samples of the same Optiva) catheter model. As with the few reported cases published in the literature, our four cases of systemic contact dermatitis induced by nickel in a catheter all incriminated the same type of catheter and the tests performed clearly demonstrated the causative role of the device. The cases of systemic contact dermatitis were seen chiefly in women in the immediate postoperative period; they could be confused with adverse drug reactions and subsequently lead to inappropriate withdrawal of treatment. The diagnosis, which was suggested by the appearance of the lesions (symmetry, involvement of skinfolds and buttocks, concomitant reaction at the injection site), history of prior episodes and a frankly positive epicutaneous nickel test, may be readily confirmed using a challenge test.