Development of metal allergy after Nuss procedure for repair of pectus excavatum despite preoperative negative skin test

Minimally invasive pectus excavatum repair (Nuss procedure, MIRPE) utilizes transthoracic implantation of metal bars for correction of chest wall deformity. Based on family or personal history, metal allergy testing is undertaken prior to operation, as rates of metal allergy in orthopedics are significant. If the patient is found to be allergic to one of the components of the dermal patch test, a titanium bar is used. Otherwise, a stainless steel bar is used. We report an adolescent boy who underwent Nuss procedure. He had neither history of drug allergies nor contact dermatitis. However, he did suffer from seasonal allergies. Preoperative patch test was negative. Twenty-seven days after Nuss procedure the patient noted a slight rash around his right and left chest incision sites. Signs and symptoms of local infection developed, with increases in erythrocyte sedimentation rate (ESR). Opening the wounds and oral antibiotics led to resolution, with only a rash remaining. Due to persistently elevated ESR values and new elevation of C-reactive protein (CRP), repeat allergy testing was performed. The repeat testing showed reaction to chromium, copper, and molybdenum, minor components of the steel bar. Resolution of his complaints was obtained only after removal of the implanted bars.