Diagnosis and management of hypersensitivity to titanium in implanted intrathecal pain pump: a case report.

BACKGROUND: Hypersensitivity reactions to implanted neuromodulation devices often mimic infection and result in device explants. Among device components, titanium is an infrequent immune irritant that can lead to implant rejection. CASE PRESENTATION: This case report describes a patient with a history of prior lumbar spine surgery and refractory low back pain who had two intrathecal pump explants for suspicion of infection and who was ultimately diagnosed to have a type IV titanium hypersensitivity. An intrathecal drug delivery system was successfully reimplanted without rejection by encasing the pump with a pouch of expanded polytetrafluoroethylene (ePTFE) fabric. CONCLUSIONS: Hypersensitivity to device components should be considered in patients with recurrent or unexplained pump site complications. The use of an ePTFE pouch may allow device reimplantation in patients with type IV hypersensitivity reactions to implanted neuromodulation devices.