Nickel Allergic Reaction post-Transcatheter Atrial Septal Defect Device Closure: A Case Report

Background: Although transcatheter device closure of atrial septal defect (ASD) is a common, safe, and effective interventional cardiac procedure, some adverse effects have been reported including device migration, cardiac erosion, and nickel allergic hypersensitivity reaction.
Objective: Here we report on an eleven-year-old boy who experienced a nickel allergic reaction after transcatheter ASD device closure, and we report on how we managed this critical situation.
Case Report: Here we report on an eleven-year-old boy who experienced a nickel allergic reaction after transcatheter device closure of a large ostium secundum ASD with a 34-mm Hyperion™ ASD occluder (Comed, Netherlands). Ten days post-procedure, the patient complained of fever, severe allergic reaction; dermatitis, and pruritic rash on his face, arms, trunk, and genital area. Dug allergic reaction and infective endocarditis was excluded. Immediately the patient was managed as a case of device-induced nickel allergic reaction. All manifestations were resolved completely after one week with high doses of dexamethasone and clopidogrel 75 mg orally for 6 months. Subsequent follow-up for 6-month post-procedure showed that the device was properly seated with no recurrence of the nickel allergic symptoms.
Conclusions: Nickel allergy and device allergic syndrome must be considered during transcatheter device closure. Despite still controversial, confirmation of a nickel allergy pre-procedure with the patch testing or with the device itself may be useful. Nickel-avoidance strategies using modified devices could be considered a treatment option for patients with nickel allergy.