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Intrathecal morphine pump associated Trichosporon infection complicated by new-onset myasthenia gravis

Jacob Gluski1, Gabrielle Santangelo2, Daniel M Sciubba3

  • 1Neurosurgery, Wayne State University, Detroit, Michigan, USA jgluski@northwell.edu.

BMJ Case Reports
|May 28, 2026
PubMed

Insights

This case report details the first instance of Trichosporon arachnoiditis in a patient with an intrathecal drug delivery pump (ITDDP). Fungal infections are rare in immunocompetent individuals, highlighting a potential complication of ITDDPs.

Area of Science:

  • Infectious Diseases
  • Neurology
  • Medical Devices

Background:

  • Fungal infections are uncommon in immunocompetent individuals.
  • Intrathecal drug delivery pumps (ITDDPs) are associated with infection risks.
  • Fungal arachnoiditis is a rare central nervous system infection.

Purpose of the Study:

  • To report the first case of Trichosporon arachnoiditis in a patient with an ITDDP.
  • To highlight the potential for rare fungal infections in patients with ITDDPs.
  • To emphasize the importance of considering fungal arachnoiditis in the differential diagnosis for ITDDP patients presenting with neurological symptoms.

Main Methods:

  • Case presentation of a patient with an ITDDP.
  • Clinical evaluation including neurological examination and imaging.
  • Surgical exploration, decompression, and tissue/fluid sampling for culture and pathology.
  • Antifungal treatment and management of complications.

Main Results:

  • The patient presented with falls and progressive lower extremity weakness.
  • Imaging revealed a compressive lesion.
  • Cultures identified Trichosporon, and pathology indicated Aspergillus.
  • The patient experienced complications including respiratory failure and voriconazole-induced hepatotoxicity.

Conclusions:

  • Intrathecal drug delivery pumps (ITDDPs) present a significant risk for infection.
  • Fungal arachnoiditis, though rare, should be considered in the differential diagnosis for patients with ITDDPs experiencing neurological decline.
  • Management of these infections requires prompt diagnosis, appropriate antifungal therapy, and careful monitoring for treatment-related complications.
Keywords:
Infection (neurology)InfectionsNeurology (drugs and medicines)Pain (neurology)Spinal cord

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