Can an intrathecal, catheter-tip-associated inflammatory mass reoccur?

Intrathecal granuloma associated to the tip of catheters implanted in patients receiving long-term spinal infusion to alleviate chronic pain is a rare but potentially catastrophic complication. Its formation seems to be related to the intrathecal administration of opioid drugs, although not all opioids induce granuloma formation with the same frequency.

In this clinical report, we describe an intrathecal granuloma that reoccur twice in the same patient after its surgical removal.

This case report highlights the incomplete knowledge about the mechanism of granuloma formation and discuss the alternatives in the management of catheter-tip granulomas. This is the first case report of a patient in whom an intrathecal granuloma reoccurred twice after initial surgical removal. We also present and discuss a potential management strategy to avoid further surgery and resume intrathecal therapy early.