Abstract
65-year old female presented with fatigue and a diffuse; erythematous; and pruritic rash. Three months prior she underwent a right total knee replacement. She reported a history of rash with costume jewelry and allergic rhinitis. A biopsy showed suspicion for contact dermatitis, and patch testing was performed. Patch testing was positive for cobalt, gold, and nickel. The surgeon confirmed cobalt contained in the prosthesis. Previous studies supported the use of omalizumab to treat nickel allergy. After discussing alternatives, she was started on subcutaneous omalizumab 300 mg q4 weeks. She initially responded well with rash and symptom resolution. However, five months after beginning omalizumab therapy, her rash recurred. A repeat biopsy was suspicious for contact dermatitis. The patient’s patch testing was positive for cobalt and nickel. The patient began mycophenolate, hydroxychloroquine, and prednisone which did not improve the rash.
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