Department of Neurosurgery, Kangwon National University, School of Medicine, Kangwon National University Hospital, Chuncheon-Si, Gangwon-Do, South Korea.
Acta Orthop Traumatol Turc. 2020 Jul;54(4):461-464. doi: 10.5152/j.aott.2020.20148.
Delayed hypersensitivity reaction to metal ions is rare and has been mostly documented among patients undergoing total joint arthroplasty with metal-on-metal bearing surfaces. Nonetheless, to our knowledge, only a few cases associated with spinal arthrodesis have been reported in the literature. The aim of this case report was to describe the clinical features of a rare 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 diagnosis of delayed-type hypersensitivity reaction to nickel that was established by a skin patch test. The chief sign and symptoms of the patient were allergic contact dermatitis along with intractable, generalized itching that started several months ago. The medical history revealed that the patient had undergone spinal arthrodesis using rods and pedicle screws approximately 15 years ago, followed by revision surgery to remove the implants. Radiological examination showed a remnant pedicle screw fragment at the third lumbar vertebra that had broken off during the removal of implants nine years ago. However, the signs and symptoms of metal hypersensitivity started shortly before the patient was referred to our hospital. We decided to remove the screw fragment as allergic contact dermatitis was refractory to medical treatment. On postoperative day one, the itching was completely resolved, although the skin patch test remained positive.
金属离子迟发性过敏反应较为罕见，主要见于接受金属对金属关节表面全关节置换术的患者。尽管如此，据我们所知，文献中仅报道了几例与脊柱融合术相关的病例。本病例报告的目的在于描述脊柱融合术后极长（约 15 年）时间后发生的罕见镍迟发性过敏反应的临床特征。本文报道了 1 例 38 岁患者，因皮肤斑贴试验确诊为镍迟发性过敏反应而被转诊至我院。该患者的主要症状和体征为过敏接触性皮炎和数月前开始的难治性全身性瘙痒。病史显示，该患者约 15 年前曾接受过脊柱融合术，使用了棒和椎弓根螺钉，随后进行了翻修手术以移除植入物。影像学检查显示，在 9 年前移除植入物时，第三腰椎的残余椎弓根螺钉断成了碎片。然而，金属过敏的症状和体征是在患者被转诊至我院前不久开始出现的。我们决定切除螺钉碎片，因为过敏接触性皮炎对药物治疗无反应。术后第一天，瘙痒完全缓解，尽管皮肤斑贴试验仍呈阳性。
