Late bacterial granuloma at an intrathecal drug delivery catheter.
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.
Lehmberg
J
J
Department of Neurosurgery, Albert-Ludwigs-University, Freiburg, Germany. lehmberg@nz.ukl.uni-freiburg.de
Scheiwe
C
C
Spreer
J
J
van Velthoven
V
V
D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002408:Catheters, Indwelling / Q000009:adverse effects*; D004388:Dura Mater / Q000276:immunology / Q000601:surgery; D004824:Epidural Space / Q000382:microbiology / Q000473:pathology / Q000601:surgery; D006099:Granuloma / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D006801:Humans; D015918:Infusion Pumps, Implantable / Q000009:adverse effects*; D007278:Injections, Spinal / Q000009:adverse effects; D017116:Low Back Pain / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D008159:Lumbar Vertebrae / Q000473:pathology / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D019635:Neurosurgical Procedures; D010148:Intractable Pain / Q000188:drug therapy; D010591:Phantom Limb / Q000188:drug therapy; D013117:Spinal Cord Compression / Q000209:etiology / Q000503:physiopathology; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D013346:Subarachnoid Space / Q000382:microbiology / Q000473:pathology / Q000601:surgery; D013530:Surgical Wound Infection / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents