ABB  Vol.4 No.1 A , January 2013
Recurrent intrathecal catheter-tip granuloma in a patient receiving high dose hydromorphone: A case report
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.
Cite this paper: Varghese, T. , Bemporad, J. , Camici, S. and Mortazavi, S. (2013) Recurrent intrathecal catheter-tip granuloma in a patient receiving high dose hydromorphone: A case report. Advances in Bioscience and Biotechnology, 4, 147-152. doi: 10.4236/abb.2013.41A022.

[1]   Medtronic Internal Communication. (2010) UC201003 915 EN NP9832 C, Medtronic, Inc.

[2]   North, R.B., Cutchis, P.N., Epstein, J.A. and Long, D.M. (1991) Spinal cord compression complicating subarachnoid infusion of morphine: Case report and laboratory experience. Neurosurgery, 29, 778-784. doi:10.1227/00006123-199111000-00025

[3]   Phillips, J.A., Escott, E.J., Moosey, J.J. and Kellermier, H.C. (2007) Imaging appearance of intrathecal catheter tip granulomas: Report of three cases and review of the literature. American Journal of Roentgenology, 189, W375 W381. doi:10.2214/AJR.07.2225

[4]   Ramsey, C.N., Owen, R.D., Witt, W.O. and Grider, J.S. (2008) Intrathecal granuloma in a patient receiving high dose hydromorphone. Pain Physician, 11, 369-373.

[5]   Coffey, R.J. and Burchiel, K.B. (2002) Inflammatory mass lesions associated with intrathecal drug infusion catheters: Report and observations on 41 patients. Neurosurgery, 50, 78-86.

[6]   Rodan, B.A., Cohen, F.L., Bean, W.J. and Martyak, S.N. (1985) Fibrous mass complicating epidural morphine in fusion. Neurosurgery, 16, 68-70. doi:10.1227/00006123-198501000-00014

[7]   Yaksh, T.L., Hassenbusch, S., Burchiel, K., Hildebrand, K.R., Page, L.M. and Coffey, R.J. (2002) Inflammatory masses associated with intrathecal drug infusion: A re view of preclinical evidence and human data. Pain Medicine, 3, 300-312. doi:10.1046/j.1526-4637.2002.02048.x

[8]   Follett, K.A. (2003) Intrathecal analgesia and catheter-tip inflammatory masses. Anesthesiology, 99, 5-6. doi:10.1097/00000542-200307000-00004

[9]   Miele, V.J., Price, K.O., Bloomfield, S., Hogg, J. and Bai les, J.E. (2006) A review of intrathecal morphine therapy related granulomas. European Journal of Pain, 10, 251 261. doi:10.1016/j.ejpain.2005.05.002

[10]   Andrés, J.D., Palmisani, S., Villanueva Pérez, V.L., An sensio, J. and Lopez-Alcaron, M.D. (2010) Can an intra thecal, catheter-tip-associated inflammatory mass reoccur? The Clinical Journal of Pain, 26, 631-364. doi:10.1097/AJP.0b013e3181e4a541

[11]   Hoederath, P., Gautschi, O.P., Land, M., Hildebrandt, G. and Fournier, J.Y. (2010) Formation of two consecutive intrathecal catheter tip granulomas within nine months. Central European Neurosurgery, 71, 39-42. doi:10.1055/s-0029-1202359

[12]   Jourdain, V., Cantin, L., Prud’Homme, M. and Fournier Gosselin, M.P. (2009) Intrathecal morphine therapy-re lated granuloma: Faster to grow then thought. Neuro modulation, 12, 164-168. doi:10.1111/j.1525-1403.2009.00205.x

[13]   Cabbell, K.L., Taren, J.A. and Sager, O. (1998) Spinal cord compression by catheter granulomas in high-dose in trathecal morphine therapy: Case report. Neurosurgery, 42, 1176-1181. doi:10.1097/00006123-199805000-00142

[14]   Deer, T., Krames, E.S., Hassenbusch, S.J., Burton, A., Caraway, D., Dupen, S., Eisenach, J., Erdek, M., Grigsby, E., Kim, P., Levy, R., McDowell, G., Mekhail, N., Pan chal, S., Prager, J., Rauck, R., Saulino, M., Sitzman, T., Staats, P., Stanton-Hicks, M., Stearns, L., Willis, K.D., Witt, W., Follett, K., Huntoon, M., Liem, L., Rathmell, J., Wallace, M., Buchser, E., Cousins, M. and Donck, A.V. (2007) Polyanalgesic consensus conference 2007: Recom mendations for the management of pain by intrathecal (in traspinal) drug delivery: Report of an interdisciplinary ex pert panel. Neuromodulation, 10, 300-328. doi:10.1111/j.1525-1403.2007.00128.x

[15]   Medel, R., Pouratian, N. and Elias, W.J. (2010) Catheter tip mass mimicking a spinal epidural hematoma. Neuro surgery, 12, 66-71.

[16]   Deer, T.R. (2004) A prospective analysis of intrathecal granuloma in chronic pain patients: A review of the literature and report of a surveillance study. Pain Physician, 7, 225-228.

[17]   Hassenbusch, S., Burchiel, K., Coffey, R.J., Cousins, M.J., Deer, T., Hahn, M., Du Pen, S., Follett, K.A., Krames, E., Rogers, J.N., Sagher, O., Staats, P.S., Wallace, M. and Willis, K.D. (2002) Management of intrathecal catheter tip inflammatory masses: A consensus statement. Pain Medicine, 3, 313-323. doi:10.1046/j.1526-4637.2002.02055.x

[18]   Blount, J.P., Remley, K.B., Yue, S.K. and Erickson, D.L. (1986) Intrathecal granuloma complicating chronic spinal infusion of morphine. Journal of Neurosurgery, 84, 272 276. doi:10.3171/jns.1996.84.2.0272