title: Delayed type IV hypersensitivity reaction to porcine acellular dermal matrix masquerading as infection resulting in multiple debridements.
abstract: Delayed type IV hypersensitivity reactions are well established in the surgical setting with respect to external exposure via topical antibiotics and internal exposure via synthetic materials. In contrast, biologic matrix is derived from decellularized human or animal tissues and is consequently believed to elicit a minimal host inflammatory response.
  
  
  
  We report a case of delayed type IV hypersensitivity reaction secondary to a biologic comprised of porcine-derived acellular dermal matrix, [Strattice™].
  
  
  
  While biologic matrix is often preferred over synthetic mesh due to its decreased risk for infection, this case emphasizes that potential for hypersensitivity to the material persists. Type IV hypersensitivity reactions should be included in the differential diagnosis for suspected post-operative infections.
authors.affiliation: Department of Dermatology, Massachusetts General Hospital, Boston, MA, 02115, USA.
authors.forename: P
authors.initials: P
authors.lastname: Vedak
authors.affiliation: Department of Dermatology, Massachusetts General Hospital, Boston, MA, 02115, USA.
authors.forename: J
authors.initials: J
authors.lastname: St John
authors.affiliation: Department of Dermatology, Massachusetts General Hospital, Boston, MA, 02115, USA.|Harvard Medical School, Boston, USA.
authors.forename: A
authors.initials: A
authors.lastname: Watson
authors.affiliation: Department of Dermatology, Massachusetts General Hospital, Boston, MA, 02115, USA.|Harvard Medical School, Boston, USA.
authors.forename: L
authors.initials: L
authors.lastname: Garibyan
authors.affiliation: Harvard Medical School, Boston, USA.|Department of Pathology, Massachusetts General Hospital, Boston, USA.
authors.forename: M C
authors.initials: MC
authors.lastname: Mihm
authors.affiliation: Harvard Medical School, Boston, USA.|Department of Pathology, Massachusetts General Hospital, Boston, USA.
authors.forename: R M
authors.initials: RM
authors.lastname: Nazarian
authors.affiliation: Department of Dermatology, Massachusetts General Hospital, Boston, MA, 02115, USA.|Harvard Medical School, Boston, USA.
authors.forename: P C
authors.initials: PC
authors.lastname: Levins
authors.affiliation: Harvard Medical School, Boston, USA.|Division of Plastic Surgery, Massachusetts General Hospital, Boston, USA.
authors.forename: C L
authors.initials: CL
authors.lastname: Cetrulo
authors.affiliation: Department of Dermatology, Massachusetts General Hospital, Boston, MA, 02115, USA.|Harvard Medical School, Boston, USA.
authors.forename: P
authors.initials: P
authors.lastname: Schalock
authors.affiliation: Department of Dermatology, Massachusetts General Hospital, Boston, MA, 02115, USA. dkroshinsky@partners.org.|Harvard Medical School, Boston, USA. dkroshinsky@partners.org.
authors.forename: D
authors.initials: D
authors.lastname: Kroshinsky
mesh_terms: D062088:Acellular Dermis / Q000009:adverse effects*; D000818:Animals; D003646:Debridement; D020878:Device Removal; D003937:Diagnosis, Differential; D003951:Diagnostic Errors; D005260:Female; D006801:Humans; D006968:Hypersensitivity, Delayed / Q000175:diagnosis* / Q000209:etiology; D019736:Prostheses and Implants / Q000009:adverse effects*; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000175:diagnosis* / Q000209:etiology; D013552:Swine
keywords: Allergic contact dermatitis; Complications; Mesh; Pseudocellulitis; Strattice; Type IV delayed type hypersensitivity reaction