Refractory urticaria,bradycardia and contact eczema in patient with nickel hypersensitivity after atrial septal defect occluder implantation.A case report.

Abstract

Event Abstract Back to Event Refractory urticaria,bradycardia and contact eczema in patient with nickel hypersensitivity after atrial septal defect occluder implantation.A case report. Kaddy J. Beltran1*, CARLOS E. OLMOS1 and Catalina Gomez1 1 Cayre IPS, Cundinamarca, Colombia Rationale Metal hypersensitivity is a frequent cause of contact eczema and a potential risk in the use of medical advices usually made with nickel, cobalt and chromium for the eventual sistemic reaction that this metals can cause. Case report A 31 year-old woman with history of eczema and pruritus with contact of jewerly,was implanted a atrial septal defect occluder in may of 2014, without immediately postprocedure reactions but 72 hours after the patient complains of intense pruritus.heaves and eczema in her back, neck and chest and progresive chest discomfort and dyspnea.The attendat phisician consider a probably reaction for nickel and start loratadin, ASA and clopidogrel. Two weeks after the reaction, the patient persists with the cutaneous and increase the cardiac simptoms,even in repose and with syncope episodes; after multiple studies the cardiologist found a persistent bradycardia de novo wich was attributed to metal hypersensitivity ,so it increase ASA and clopidogrel and refers to allergologist service: we did skin patch test that was positive to nickel and cobalt and started fexofenadin,topic steroid and topic calcineurin inhibitors achieving partial skin responsive but persist with bradycardia and chest dyscomfort. Then the patient was assesed by cardiology and cardiac surgery who founded a giant atrial septum aneurysm involves de amplatzer so she wasn´t candidate to removal by eventual life-threatening, which requires continuing pharmacological treatment included montelukast and cardiac rehabilitation with partial control of hives and eczema but persistent bradycardia without new syncope episodes. Conclusions Nickel hypersensitivity is reported in 15-17% of population and is the most frequent cause of contact dermatitis.The use of medical advices with metal components suppose a risk that has been assesed in different studies and specifically in atrial septal defect occluder finding that 2% of this patients had effects atributable to nickel allergy like hives, chest pain, migraine and pericardial effusion; that was described 48 hours to 30 days after de implantation of the advice and resolved with use of antihistamines,antiplatelet y anticoagulant for 30 to 60 days with total resolution and without relapse after discontinuation. We just found one case report of a similar case who doesn´t improve with farmacological therapy and need to removed the amplatzer with total resolution of the symptoms. In this case we present a clinical and therapeutical challenge about the severity of the symptoms and the imposibility of removal the device, thus it was necessary adjust the pharmacological protocol and stablish a multidsclipinary staff for her management and follow up.