Titanium Allergy: A Case of Foreign Body Reaction Following Laparoscopic Cholecystectomy

Titanium is widely regarded as a biocompatible and inert material commonly used in surgical implants. Despite this reputation, hypersensitivity reactions to titanium, though rare, can lead to persistent and unexplained postoperative symptoms. We report the case of a 76-year-old woman who developed progressive right upper quadrant abdominal pain, burning sensations, neuropathic symptoms, and fatigue three months after laparoscopic cholecystectomy in which titanium clips were used. Her history included documented systemic intolerance to a titanium dental implant 10 years earlier, which had required removal. Extensive laboratory and imaging evaluation was unremarkable. Titanium hypersensitivity was clinically suspected based on the temporal association between clip placement and symptom onset, along with systematic exclusion of alternative causes. MELISA® (memory lymphocyte immunostimulation assay) testing was discussed, but declined due to cost and extended turnaround time. Following diagnostic laparoscopy and removal of the four titanium clips approximately three months after symptom onset, the patient experienced complete symptom resolution within one week. She remains asymptomatic at six-month follow-up. This case highlights the importance of considering metal hypersensitivity in patients with unexplained postoperative symptoms and prior exposure to implants. Increased awareness and selective preoperative screening, particularly evaluation for prior metal intolerance, may help prevent unnecessary morbidity and repeated interventions.