Unusual Presentation of Nickel Allergy Requiring Explantation of an Amplatzer Atrial Septal Occluder Device

Abstract

Systemic allergic reaction to a percutaneous patent foramen ovale (PFO) occlusion device is a rare event with only scattered reports in the literature. Serious allergic reactions to these devices have a poorly defined incidence, presentation, and natural history. We present a woman with a previously unknown nickel allergy who developed severe chest pain beginning the morning after percutaneous device closure of the PFO. Despite multiple visits to her cardiologists and primary care physicians, the cause of her chest pain remained unclear. After seeking a second opinion at our medical center, skin testing showed a severe reaction to nickel. These symptoms were refractory to treatment until device explantation 18 mo later. This case highlights the importance of recognizing nickel allergy as a cause of chest pain following implantation of certain types of devices used for closure of PFOs and other heart defects.