Titanium hypersensitivity in a patient with a titanium medical implant

Ana G. Lopes, Department of Dermatology and Venereology, Hospital de Braga, Braga, Portugal Teresa Pereira, Department of Dermatology and Venereology, Hospital de Braga, Braga, Portugal Maria J. Guimarães, Department of Dermatology and Venereology, Hospital de Braga, Braga, Portugal Catarina Cerqueira, Department of Dermatology, Hospital de Braga, Braga, Portugal Joana Gomes, Department of Dermatology, Hospital de Braga, Braga, Portugal Celeste Brito, Department of Dermatology and Venereology, Hospital de Braga, Braga, Portugal

A 53-year-old male patient with priors of psoriasis suffered a left tibial plateau fracture and underwent open reduction and internal fixation with a titanium plating system. He had no history of atopy or contact-hypersensitivity reactions to metals. Almost 1 year later, the patient continued to have chronic pain and edema at the site of the implant. On examination, the patient had a well-healed surgical incision on the left leg without erythema or induration but with tenderness to touch and two fluctuating nodular lesions. Subsequent allergy patch testing revealed an allergy-positive reaction to nickel sulfate, titanium oxalate and sodium tetrachloropalladate. The patient was diagnosed with titanium hypersensitivity secondary to recent implantation. The patient underwent hardware removal with a resolution of the complaints. The allergic risk of titanium material is smaller than that of other metal materials. Positive patch test reactions to titanium are rare and a negative patch does not exclude the diagnosis. Preimplant patients should be asked about a history of hypersensitivity reactions to metals and patch testing should be recommended for those who have experienced such reactions.

Palabras clave: Allergy. Medical implant. Patch testing. Titanium. Titanium hypersensitivity.