Pain
Sergio Mosquera Limas, DO
Resident, PGY-2
Yale New Haven Hospital
New Haven, Connecticut, United States
Schan Lartigue, MD
Resident, PGY-2
Yale New Haven Hospital
New Haven, Connecticut, United States
Christina Mtanes, MD
Resident, PGY-1
Yale New Haven Hospital
New Haven, Connecticut, United States
Charles A. Odonkor, MD, MA, FAAPMR
Assistant Professor of Orthopedics & Rehabilitation
Yale University School of Medicine
NEW HAVEN, Connecticut, United States
sergio Mosquera Limas, DO
Yale New Haven Hospital
New Haven, Connecticut, United States
Cervicalgia and occipital neuralgia complicated by severe hypersensitivity reaction to temporary PNS.
Case Description:
A 65-year-old female with cervicalgia, occipital neuralgia, cervical radiculitis, and severe foraminal stenosis at C5-C6, deemed a poor surgical candidate, underwent peripheral nerve stimulation (PNS) with placement of a right occipital nerve C2-3 cervical medial branch lead (Sprint Microlead 2.0 with external pulse generator) for chronic pain management. Within 48 hours, she developed a progressive erythematous, pruritic rash at the implant site accompanied by chest tightness, flushing, and dyspnea. Symptoms began the day after implantation and worsened despite antihistamines and oral steroids. On evaluation, she was hypertensive and tachycardic, with raised erythematous lesions localized to the right neck without drainage or evidence of infection. Dressing changes with hypoallergenic materials failed to improve symptoms. Concern for systemic hypersensitivity led to urgent device explantation. Following lead removal, her rash and pruritus improved significantly with topical steroids and supportive care, consistent with a severe hypersensitivity reaction to the implanted device.
Discussions:
Temporary PNS provides a minimally invasive option for refractory pain in nonsurgical candidates, with generally favorable outcomes. Complications include infection, lead migration, and rarely, hypersensitivity reactions. This case highlights severe allergic dermatitis with systemic manifestations requiring device removal. Such reactions may mimic infection or acute systemic illness, complicating diagnosis. Reported causes include dressing adhesives, material intolerance, or metallosis from nickel-based products. Early recognition of hypersensitivity is essential to prevent escalation and ensure patient safety.
Conclusions:
This case highlights a rare but clinically relevant complication of temporary PNS: severe hypersensitivity with systemic symptoms requiring urgent explantation. Clinicians should maintain vigilance for dermatologic or systemic reactions following PNS procedures. Prompt identification and intervention are essential to patient safety and therapeutic outcomes. Reporting such cases raises awareness, informs pre-implant counseling, and underscores the need for ongoing refinement of device materials.
