SHM Converge Scientific Abstract ePoster Gallery-Infection at the Core: The Challenge of Diagnosing Inthrathecal Pump-Associated Bacterial Meningitis

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This case report describes a 76-year-old man with cerebral palsy, diabetes, and an intrathecal baclofen pump who developed worsening headache, vomiting, weakness, hallucinations, and seizures. He was treated empirically for meningitis, and MRI later showed leptomeningeal enhancement and ventriculitis, strongly suggesting central nervous system infection.<br /><br />However, the initial lumbar puncture, which was delayed because it required interventional radiology, did not show pleocytosis and had negative culture, meningitis/encephalitis panel, and metagenomic testing. These negative results lowered suspicion for bacterial meningitis despite the patient’s worsening clinical course.<br /><br />On hospital day 11, cerebrospinal fluid obtained by direct aspiration of the intrathecal pump revealed marked inflammation with elevated white blood cells and low glucose, and culture eventually grew Pseudomonas aeruginosa. After pump removal and 28 days of ceftazidime, the patient recovered to baseline.<br /><br />The report highlights an important diagnostic problem: meningitis associated with intrathecal pumps may not be detected by conventional lumbar puncture, especially when LP is delayed. Because there is no guideline recommending routine pump aspiration, diagnosis may be missed or delayed. The authors conclude that clinicians should not let negative lumbar puncture findings rule out meningitis when clinical and imaging evidence is compelling, and they should consider early aspiration of the intrathecal pump to improve diagnostic yield and guide timely treatment.

Asset Subtitle

Elita R. Delbruck

Meta Tag

Author List Elita R. Delbruck, Yan Xing

Category Clinical Vignettes

Concept Intrathecal Pump-Associated Meningitis

Concept Intrathecal Pump

Concept Meningitis

Concept Intrathecal Pump Aspiration

Concept Lumbar Puncture

Distinguished Non-Finalist

Presenter Organization UC San Diego

Presenting Author Elita R. Delbruck

Track Adult

Keywords

intrathecal baclofen pump

Pseudomonas aeruginosa

meningitis

cerebrospinal fluid aspiration

lumbar puncture

ventriculitis

leptomeningeal enhancement

central nervous system infection

metagenomic testing

pump removal

Intrathecal Pump-Associated Meningitis

Intrathecal Pump

Meningitis

Intrathecal Pump Aspiration

Lumbar Puncture