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.