Intrathecal morphine pump associated Trichosporon infection complicated by new-onset myasthenia gravis

Fungal infections in immunocompetent patients—even those with intrathecal drug delivery pumps (ITDDPs)—are exceedingly rare. This is the first report of Trichosporon arachnoiditis in a patient with an ITDDP. The patient presented with falls and progressive lower extremity weakness. Imaging showed a compressive lesion, for which the patient was taken for exploration and decompression. Cultures grew Trichosporon and pathology showed fungus consistent with Aspergillus . The patient’s recovery was complicated by respiratory failure requiring re-intubation secondary to an exacerbation of myasthenia gravis. Additionally, the patient developed cholestatic hepatotoxicity from voriconazole requiring biliary sphincterotomy and replacement of voriconazole. ITDDPs pose a significant risk of infection, and although fungal arachnoiditis is rare, it should be considered in the differential diagnosis in this patient population.