{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T12:19:59Z","timestamp":1788437999133,"version":"build-2803163510"},"reference-count":13,"publisher":"BMJ","issue":"5","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2026,5,5]]},"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:p>\n                    Fungal infections in immunocompetent patients\u2014even those with intrathecal drug delivery pumps (ITDDPs)\u2014are exceedingly rare. This is the first report of\n                    <jats:italic>Trichosporon<\/jats:italic>\n                    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\n                    <jats:italic>Trichosporon<\/jats:italic>\n                    and pathology showed fungus consistent with\n                    <jats:italic>Aspergillus<\/jats:italic>\n                    . The patient\u2019s 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.\n                  <\/jats:p>","DOI":"10.1136\/bcr-2025-271727","type":"journal-article","created":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T12:30:23Z","timestamp":1779971423000},"page":"e271727","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Intrathecal morphine pump associated\n                    <i>Trichosporon<\/i>\n                    infection complicated by new-onset myasthenia gravis"],"prefix":"10.1136","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7024-3273","authenticated-orcid":false,"given":"Jacob","family":"Gluski","sequence":"first","affiliation":[{"name":"Neurosurgery, Wayne State University, Detroit, Michigan, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabrielle","family":"Santangelo","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Northwell Health, New Hyde Park, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel M","family":"Sciubba","sequence":"additional","affiliation":[{"name":"Northwell Health, Manhasset, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jamie","family":"Nieto","sequence":"additional","affiliation":[{"name":"Northwell Health, Manhasset, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,5,27]]},"reference":[{"key":"2026090305101138000_19.5.e271727.1","doi-asserted-by":"crossref","first-page":"1691","DOI":"10.1212\/01.wnl.0000311391.00944.c4","article-title":"Assessment: Botulinum neurotoxin for the treatment of spasticity (an evidence-based review): report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology","volume":"70","author":"Simpson","year":"2008","journal-title":"Neurology May"},{"key":"2026090305101138000_19.5.e271727.2","doi-asserted-by":"publisher","DOI":"10.1016\/S0090-3019(01)00353-6"},{"key":"2026090305101138000_19.5.e271727.3","doi-asserted-by":"publisher","DOI":"10.3171\/2009.6.PEDS0921"},{"key":"2026090305101138000_19.5.e271727.4","doi-asserted-by":"publisher","DOI":"10.1097\/00000542-200406000-00034"},{"key":"2026090305101138000_19.5.e271727.5","doi-asserted-by":"crossref","first-page":"106630","DOI":"10.1016\/j.clineuro.2021.106630","article-title":"Complications of intrathecal drug delivery therapy (ITDD): A retrospective study of 231 implantations between 1999 and 2014","volume":"205","author":"Necking","year":"2021","journal-title":"Clin Neurol Neurosurg"},{"key":"2026090305101138000_19.5.e271727.6","doi-asserted-by":"crossref","DOI":"10.1038\/s41394-023-00610-5","article-title":"The presence of Candida parapsilosis with intrathecal baclofen pump in a person with high cervical spinal cord injury; infection or colonization? A Case Report","volume":"9","author":"Chan","year":"2023","journal-title":"Spinal Cord Ser Cases"},{"key":"2026090305101138000_19.5.e271727.7","doi-asserted-by":"crossref","first-page":"1159","DOI":"10.1016\/j.jocn.2012.08.017","article-title":"Aspergillus arachnoiditis post intrathecal baclofen pump insertion","volume":"20","author":"Vivek","year":"2013","journal-title":"J Clin Neurosci"},{"key":"2026090305101138000_19.5.e271727.8","article-title":"Voriconazole-Induced Cholestatic Hepatotoxicity in an Immune Competent Patient","volume":"14","author":"Mohammed","year":"2022","journal-title":"Cureus"},{"key":"2026090305101138000_19.5.e271727.9","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra0808853"},{"key":"2026090305101138000_19.5.e271727.10","doi-asserted-by":"crossref","first-page":"642","DOI":"10.1001\/jamadermatol.2014.5462","article-title":"Trichosporon inkin as an Emergent Pathogen in Patients With Severe Pemphigus","volume":"151","author":"Nobrega de Almeida J\u00fanior","year":"2015","journal-title":"JAMA Dermatol"},{"key":"2026090305101138000_19.5.e271727.11","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1002\/mus.27832","article-title":"Myasthenic crisis","volume":"68","author":"Claytor","year":"2023","journal-title":"Muscle Nerve"},{"key":"2026090305101138000_19.5.e271727.12","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/civ482"},{"key":"2026090305101138000_19.5.e271727.13","unstructured":"Castano G YS , Mada PK . Trichosporonosis. In: Treasure island (FL). StatPearls Publishing, 2025. Available: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK482477\/"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2025-271727","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T12:10:20Z","timestamp":1788437420000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2025-271727"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5]]},"references-count":13,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,5,27]]},"published-print":{"date-parts":[[2026,5]]}},"alternative-id":["10.1136\/bcr-2025-271727"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2025-271727","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5]]}}}