title: Recurrent cellulitis associated with long-term intrathecal opioid infusion therapy: a case report and review of the literature.
abstract: BACKGROUND
  Lower-limb edema is recognized as an untoward side effect of intrathecal opioid therapy. Cellulitis, an acute, spreading pyogenic inflammation of the dermis and subcutaneous tissue, predisposed by persistent leg edema, can become problematic in patients on intraspinal opioid infusion therapy.
  
  
  OBJECTIVE
  To present a case of recurrent cellulitis in an elderly lady with persistent leg edema associated with intrathecal morphine/hydromorphone infusion therapy.
  
  
  METHODS
  Sixty-one-year-old woman with intractable chronic low back pain and bilateral leg pain treated with an intrathecal infusion of morphine up to 5 mg/day over 3 months with satisfactory pain control developed progressive lower extremity edema, complicated by recurrent cellulitis, requiring repeated hospitalization and intravenous antibiotic treatment. Switching to intrathecal hydromorphone helped minimally. Intrathecal baclofen and clonidine infusion resulted in complete resolution of leg edema and pain relief over the following 12 months.
  
  
  CONCLUSIONS
  Intrathecal Baclofen and Clonidine may be used as alternatives to provide spinally mediated antinociception when intraspinal opioid fails due to pharmacological side effects such as persistent edema.
authors.affiliation: Physicians' Pain Specialists of Alabama, Mobile, Alabama 36607, USA. xiuluruan@yahoo.com
authors.forename: Xiulu
authors.initials: X
authors.lastname: Ruan
authors.forename: Hainan
authors.initials: H
authors.lastname: Liu
authors.forename: J Patrick
authors.initials: JP
authors.lastname: Couch
authors.forename: Frank
authors.initials: F
authors.lastname: Wang
authors.forename: Srinivas
authors.initials: S
authors.lastname: Chiravuri
mesh_terms: D000701:Analgesics, Opioid / Q000009:adverse effects* / Q000627:therapeutic use; D001418:Baclofen / Q000627:therapeutic use; D002481:Cellulitis / Q000139:chemically induced*; D003000:Clonidine / Q000627:therapeutic use; D004487:Edema / Q000139:chemically induced; D005260:Female; D018755:GABA Agonists / Q000627:therapeutic use; D006801:Humans; D004091:Hydromorphone / Q000627:therapeutic use; D007278:Injections, Spinal / Q000009:adverse effects*; D017116:Low Back Pain / Q000188:drug therapy; D008875:Middle Aged; D012008:Recurrence; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid; D018755:GABA Agonists; D001418:Baclofen; D003000:Clonidine; D004091:Hydromorphone