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A Patient with an Intradural Tumor: An Unexpected Finding
Devang Padalia1, Allan R Escher1, Nasrin N Aldawoodi2
1Anesthesiology/Pain Medicine, H. Lee Moffitt Cancer Center and Research Institute, Tampa, USA.
Cureus
|April 1, 2020
Summary
Intrathecal drug delivery systems (IDDS) manage chronic back pain but can cause granulomas. A patient with worsening pain and weakness was found to have a spinal tumor, not a granuloma, highlighting the need for broad differential diagnoses.
Area of Science:
- Neurosurgery
- Neurology
- Oncology
Background:
- Intrathecal drug delivery systems (IDDS) are used for refractory chronic back pain.
- These systems deliver opioids directly to cerebrospinal fluid but carry risks, including catheter-tip granulomas.
- Catheter-tip granulomas can cause severe neurological deficits.
Observation:
- A 38-year-old male with an IDDS for retroperitoneal fibrosis-related pain experienced escalating back pain and new lower extremity weakness.
- Initial suspicion for a catheter-tip granuloma prompted recommendations for urgent spine imaging.
- The patient's delayed imaging revealed an intradural mass causing spinal cord compression.
Findings:
- Surgical resection and subsequent pathology confirmed a malignant spinal tumor, not a granuloma.
- This case underscores that symptoms mimicking catheter-tip granulomas can arise from other serious pathologies.
Implications:
- Patients with IDDS experiencing worsening pain or new neurological deficits require prompt neuroimaging.
- The differential diagnosis for such symptoms must extend beyond catheter-tip granulomas to include neoplasms and abscesses.
- Early and accurate diagnosis is critical for effective management and preventing permanent neurological damage.
