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Published on: October 29, 2019
Late bacterial granuloma at an intrathecal drug delivery catheter
J Lehmberg1, C Scheiwe, J Spreer
1Department of Neurosurgery, Albert-Ludwigs-University, Freiburg, Germany. lehmberg@nz.ukl.uni-freiburg.de
Abstract:
In the case reported, neurological complaints were pain and dysaesthesiae in the lower back and thigh, as well as paresis of the ileopsoas muscle. MRI of the lumbar spine showed an intradural-extramedullary mass at the level of L1 homogeneously enhancing with gadolinium. This mass was situated at the tip of an intrathecal catheter implanted 11 years before for a morphine trial infusion as therapy for phantom pain after amputation of the right arm. Now, removal of the catheter was performed. Cultures of lumbar CSF and the catheter tip demonstrated coagulase negative staphylococcus. Antibiotic medication with cephalosporines was given for 6 weeks. After removal of the catheter, the patient was free of pain and he progressively regained full neurological function. Although most catheter-associated granulomas reported so far were sterile in nature, bacterial infection should still be considered even years after catheter placement.
Insights
A long-term intrathecal catheter infection caused neurological issues years after placement. Prompt diagnosis and removal resolved pain and restored function, highlighting the need to consider infection in delayed complications.
Area of Science:
- Neurology
- Infectious Diseases
- Neurosurgery
Background:
- Intrathecal catheters are used for chronic pain management.
- Complications can arise years after implantation.
- Delayed neurological deficits may indicate infection.
Observation:
- A patient presented with lower back pain, thigh pain, and ileopsoas muscle paresis.
- MRI revealed an intradural-extramedullary mass at L1, associated with an 11-year-old intrathecal catheter.
- Coagulase-negative staphylococcus was identified from cerebrospinal fluid and catheter tip cultures.
Findings:
- Surgical removal of the intrathecal catheter was performed.
- The patient received 6 weeks of cephalosporin antibiotic treatment.
- Post-removal, the patient experienced complete pain relief and neurological recovery.
Implications:
- Bacterial infection should be considered in delayed complications of intrathecal catheters, even years later.
- Early diagnosis and intervention, including catheter removal and antibiotics, are crucial for favorable outcomes.
- This case underscores the importance of long-term monitoring for potential infectious complications associated with implanted devices.
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