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Case Report

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

Silas Fugger, Alexander Kauffmann, and Heinrich Dickel

Volume 10 (2026) p. 145 - 150

Abstract

Allergologie select, Vol. 10/2026 (145-150)

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

Silas Fugger¹, Alexander Kauffmann², and Heinrich Dickel¹

¹Department of Dermatology, Venereology and Allergology, St. Josef Hospital, University Medical Center, Bochum, and ²Chair for Materials Science and Engineering, Institute for Materials, Faculty of Mechanical Engineering, Ruhr University Bochum, Bochum, Germany
Background: 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. Case report: 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. Conclusion: 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.Correspondence to:
Silas Fugger, Department of Dermatology, Venereology and Allergology, Ruhr University Bochum, Gudrunstraße 56, 44791 Bochum, Germany
Email: [email protected]

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