TITLE:
Recurrent intrathecal catheter-tip granuloma in a patient receiving high dose hydromorphone: A case report
AUTHORS:
Teena Varghese, Joshua Bemporad, Stefano Camici, Steven Mortazavi
KEYWORDS:
Catheter-Tip Granuloma; Intrathecal; Hydromorphone; Morphine; Spinal Cord; Catheter Access Study
JOURNAL NAME:
Advances in Bioscience and Biotechnology,
Vol.4 No.1A,
January
31,
2013
ABSTRACT: Study Design: Case report. Patient
Sample: A 42- year-old Caucasian male. Results: Catheter-tip granuloma
formation is possible despite a normal catheter access study in patients with
intrathecal (IT) infu- sion systems and its recurrence is possible after surgical
excision. Increasing concentrations of hydromorphone from 50 mg/ml to 100 mg/ml
without altering the daily dosage may have precipitated granuloma
formation. Conclusions: In patients with previously
implanted spinal catheters for intrathecal drug delivery, catheter
access studies cannot be relied upon to rule out catheter-tip granulomas, which
should be included in the differential diagnosis in patients with worsening
clinical conditions or new onset neurologic symptoms. Caution should be
exercised when increasing concentrations of intrathecal opioids while monitoring
for signs or symptoms of intrathecal catheter- tip granuloma formation. Removal
of previously implanted catheters and/or reductions in opioid concentrations
may be necessary to prevent recurrent granuloma formations, which can occur
quickly after surgical excision.