title: Can an intrathecal, catheter-tip-associated inflammatory mass reoccur?
abstract: OBJECTIVE
  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.
  
  
  METHODS
  In this clinical report, we describe an intrathecal granuloma that reoccur twice in the same patient after its surgical removal.
  
  
  CONCLUSIONS
  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.
authors.affiliation: The Anaesthesia, Critical Care and Multidisciplinary Pain Management Department, General University Hospital, Valencia, Spain. deandres_jos@gva.es
authors.forename: José
authors.initials: J
authors.lastname: De Andrés
authors.forename: Stefano
authors.initials: S
authors.lastname: Palmisani
authors.forename: Vicente L
authors.initials: VL
authors.lastname: Villanueva Pérez
authors.forename: Juan
authors.initials: J
authors.lastname: Asensio
authors.forename: Maria Dolores
authors.initials: MD
authors.lastname: López-Alarcón
mesh_terms: D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use; D002408:Catheters, Indwelling / Q000009:adverse effects*; D005260:Female; D015745:Granuloma, Foreign-Body / Q000209:etiology* / Q000473:pathology* / Q000601:surgery; D006801:Humans; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage / Q000627:therapeutic use; D012008:Recurrence; D013118:Spinal Cord Diseases / Q000209:etiology* / Q000473:pathology* / Q000601:surgery
chemical_list: D000701:Analgesics, Opioid; D009020:Morphine