gms | German Medical Science

Objective: We present a rare case of allergic reaction to components of the pulse generator for deep brain stimulation and the treatment with a custom made silicone-coated pulse generator.

Method: A 53-year-old man underwent generator and stereotactic electrode implantation for Parkinson’s disease. The patient suffered repeated admissions for iterative sterile wound necrosis, leading to three repositionings and one exchange of the pulse generator. The latter was covered with a Dacron pouch. On the fourth admission the patient presented with a bacterial wound infection and the generator as well as the extensions of the electrodes had to be removed. 7 months later a silicone-coated pulse generator, custom-made for this case and two regular extensions were implanted.

Results: Dermatologic investigations using the manufacturer’s allergy kit and standard epicutaneous tests revealed an allergic reaction against gold only, which is no component of the generator casing. Histopathological findings showed lymphoplasmacytic infiltrations and eosinophilic granulocytes indicating an allergic contact dermatitis. After the implantation of the silicon-coated generator there has been no recurrence of wound complications.

Conclusions: Despite negative skin patch testing an allergic reaction to generator components is a possible cause for wound healing disorders. In such cases a custom-made silicone coated model is an effective treatment option.