Titanium hypersensitivity in a patient with a titanium medical implant

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.