Systemic Inflammatory Symptoms Following Mastectomy With Nickel-Containing Surgical Clips: A Case Report

Systemic inflammatory symptoms, such as metal hypersensitivity to surgical materials, are uncommon but very underrecognized complications that may present with persistent systemic and musculoskeletal symptoms.This case involves a 36-year-old female with a BRCA2 mutation who underwent bilateral prophylactic mastectomy with immediate breast implant reconstruction.Approximately four weeks after surgery, she developed bilateral fatigue, hand, foot, and ankle swelling, severe joint pain, and muscle weakness, leading to significant difficulty in performing activities of daily living.Subsequently, she was diagnosed with rheumatoid arthritis.She proceeded to pursue multiple treatments, including corticosteroids and various integrative therapies.About six years later, chest radiography incidentally revealed retained surgical metallic clips located at the mastectomy sites.The clips were identified as Ethicon T20 titanium clips containing trace amounts of nickel.The patient then recalled a history of allergic contact dermatitis associated with nickel-containing jewelry, and further lymphocyte transformation testing (LTT) reported reactivity to both nickel and iron.Following difficulty locating a surgeon willing to remove the clips, the patient underwent surgical removal of 19 retained clips using intraoperative fluoroscopic guidance.This case highlights the diagnostic challenges associated with persistent postoperative systemic symptoms and the importance of considering uncommon variables, such as metal hypersensitivity, in patients with unexplained prolonged inflammatory and musculoskeletal symptoms following implantation or placement of surgical materials.