Scar Tissue Catheter Tip Occlusion From an Intrathecal Baclofen Delivery: A Case Report and Review of the Literature

Abstract

Intrathecal morphine is associated with the complication of catheter tip granuloma which causes symptoms of decreased pain control, increased required dose, and neurological deficit. Catheter tip granulomas from intrathecal baclofen are thought to never occur because of the mechanism by which intrathecal morphine causes granulomas. We present a case of an intrathecal baclofen induced scarring of a catheter tip with clinical characteristics similar to some symptoms of granuloma. A 66-year-old woman with multiple sclerosis induced spasticity was partially controlled with intrathecal baclofen delivery at an extremely high dose of 1638 micrograms per day. She presented in the hospital with symptoms of withdrawal from intrathecal baclofen and required an emergency revision of her baclofen pump. Replacement of the catheter demonstrated complete occlusion of the catheter tip by scar tissue. Following surgery, her spasticity was well-controlled at the much lower dose of 200 micrograms per day. Intrathecal baclofen delivery can cause catheter tip scarring which causes some symptoms similar to catheter tip granuloma. Early recognition of these signs of catheter tip occlusion could help prevent progression to withdrawal.

Keywords: catheter-tip granuloma; drug withdrawal; intrathecal baclofen therapy; intrathecal opioids; muscle spasticity.

Figure 1. Photo after explant of scar tissue completely occluding the catheter tip from several years of intrathecal baclofen therapy

Figure 2. Microscopic pathology at 10x magnification of H&E stained scar tissue at the catheter tip demonstrates a lack of inflammatory cells. Inflammatory cells would be expected in a catheter tip granuloma

H&E: Hematoxylin and eosin