Introduction
Intrathecal drug delivery a method of directly administering opioid and
spasmolytic medication to the site of action, the spinal cord (1).
Efficacy and safety of this delivery system is well documented in cancer
pain, spacticity as well as non-malignant pain (2). However, there are a
number of recognised potential complications with this therapy. One of
the most serious of which is the formation of a granuloma occurring at
the intrathecal catheter tip, which appears to be related to the
concentration and drug type being delivered (1). Evidence has indicated
that delivery of high dose morphine can lead to the formation of these
granulomas (3, 4). Occurring in less that 3% of all patients with an
intrathecal catheter, granulomas can present as an inflammatory mass on
imaging with some resulting in compression of the spinal cord (5).
Patients may present with a host of neurological symptoms dependent on
the location of cord compression caused by the granuloma, including
neurological deficits, myelopathy and radiculopathy.
An important differential to consider in patients with intrathecal
catheters presenting with neurological deficits is transverse myelitis
(TM). TM is a neuroinflammatory condition affecting the spinal cord. It
can present as a loss of corticospinal, autonomic and spinothalamic
functional loss below the level of the lesion (6). TM has been reported
to result from intrathecal device related infections, but may also be a
consequence of demyelinating disorders, such as multiple sclerosis and
neuromyelitis optica, vascular causes and malignancies, such as
lymphoma. Therefore, early recognition of the cause of TM is paramount
in preventing irreversible paralysis and further neurological deficits
(7).
Here we report a case of transverse myelitis, caused by a B cell
lymphoma, in a patient with an intra-thecal catheter.