A rare case of delayed hypersensitivity reaction to metal ions secondary to a remnant pedicle screw fragment after spinal arthrodesis

Delayed hypersensitivity reaction to metal ions is rare and has been mostly documented among patients undergoing totaljoint arthroplasty with metal-on-metal bearing surfaces. Nonetheless, to our knowledge, only a few cases associated withspinal arthrodesis have been reported in the literature. The aim of this case report was to describe the clinical features of arare case of delayed-type hypersensitivity reaction to nickel that occurred after an extraordinarily long period of time (approximately 15 years) after spinal arthrodesis. Here, we present a 38-year-old patient who was referred to us with a diagnosisof delayed-type hypersensitivity reaction to nickel that was established by a skin patch test. The chief sign and symptoms ofthe patient were allergic contact dermatitis along with intractable, generalized itching that started several months ago. Themedical history revealed that the patient had undergone spinal arthrodesis using rods and pedicle screws approximately 15years ago, followed by revision surgery to remove the implants. Radiological examination showed a remnant pedicle screwfragment at the third lumbar vertebra that had broken off during the removal of implants nine years ago. However, thesigns and symptoms of metal hypersensitivity started shortly before the patient was referred to our hospital. We decided toremove the screw fragment as allergic contact dermatitis was refractory to medical treatment. On postoperative day one, theitching was completely resolved, although the skin patch test remained positive.

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