Intramedullary abscess associated with intrathecal morphine pump: a case report
Giovanna Zambo Galafassi, Helvécio Neves Feitosa Filho, Saulo Barros Teixeira, Murilo Medeiros Alvarenga, Marcos Antônio Pereira do Rêgo, Dante Picciotti, Marco Túlio Sette dos Santos, Marco Prist Filho, Jorge Roberto Pagura
Abstract
Introduction: Intramedullary abscesses are extremely rare, with less than 140 cases described in the literature. The prevalence is higher in children, and frequently associated with dermoid cysts and congenital malformations. They tend to develop in patients with systemic diseases leading to immunodeficiencies, such as diabetes mellitus, in patients with congenital abnormalities, adjacent spinal infection, or in use of intravenous drugs. Case report: Female patient, 48 years-old, was admitted with progressive paraplegia initiated one year ago. Multiple comorbidities, including Marfan syndrome, congenital femoral/hip malformation and bilateral visual deficit were found. She had an insertion of intrathecal morphine pump over five years ago because of chronic lower limb pain. On thoracolumbar magnetic resonance imaging, an irregular and infiltrating contrast-enhanced mass centered in the medullary canal was found. The lesion extended over 15 cm from T8 to L1. Microsurgical resection of the lesion was indicated. After myelotomy, multiple purulent foci were identified. The analysis of the collected material and morphine pump confirmed the presence of Serratia marcescens. Cefepime and vancomycin were initiated according to the infectologist’s orientation, with a plan to keep treatment for 6 weeks. Although the patient maintained neurological deficits after surgery, there was an improvement in pain control. However, the patient progressed to death 30 days after surgery due to cardiorespiratory arrest, probably secondary to cardiac complications. Discussion: Intramedullary spinal cord abscess (ISCA) is a rare neurological entity in spinal cord infection, with more than 140 cases described in the literature since its first description in 1830. These infections are traditionally correlated with high morbidity and mortality. There is a relationship between comorbidities and increased incidence of ISCA, including immunosuppression, diabetes, intravenous drug use, alcoholism, infective endocarditis, genitourinary infections, lung disease, and trauma. Escherichia coli, Staphylococcus aureus, and Mycobacterium tuberculosis are the most reported agents. We found another case in the literature featuring Serratia marcescens. Both cases involved critical, and severe intramedullary abscesses that demanded aggressive interventions, such as laminectomy and surgical drainage. We also found another case related to intrathecal morphine pump, raising concerns regarding possible complications of this device. Conclusion: The presence of intramedullary abscesses caused by intrathecal morphine pumps reveals significant insights into complications of such devices, emphasizing the need for diligent monitoring and management due to severe neurological issues and infections linked to the pumps.
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References
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Submitted date:
03/19/2025
Accepted date:
03/23/2025
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