Contact allergy to a titanium port catheter: Diagnostic challenges and clinical resolution

Titanium and its alloys are widely used in modern medical devices because of their favorable biocompatibility and mechanical properties. Allergic reactions to titanium-based implants are considered rare, and their diagnosis is hampered by the poor dermal penetration of metallic allergens.

A 29-year-old female patient with seronegative myasthenia gravis requiring parenteral nutrition presented with persistent inflammatory dermatitis overlying a titanium port catheter (X-Port BARD Titan low-profile) 4 weeks after implantation in July 2023. Despite initial diagnostic uncertainty and sequential management modifications, her condition continued to deteriorate. Similar eruptions developed after re-implantation of the same titanium port model on the contralateral thorax. Rigorous patch testing incorporating standardized tape-stripping and extended reading intervals revealed positive sensitization to the titanium port body, while all other port components and an alternative plastic port system (BARD SlimPort M.R.I. Ultra Low-Profile) tested negative. Energy-dispersive X-ray spectroscopy confirmed the titanium body composition as a Ti-Al6-V4 alloy. Substitution with the plastic port catheter in February 2025 resulted in complete symptom resolution, with sustained clinical remission through July 2025.

Although very uncommon, contact sensitization to titanium medical devices can occur and may present significant diagnostic and therapeutic challenges. Rigorous patch testing methodology, incorporating standardized tape-stripping and extended 168-hour readings, appears essential for detecting delayed-type hypersensitivity to metallic implants. Clinical resolution following biocompatible device substitution supports an allergic etiology in this case.