BACKGROUND: Cancer-related pain from metastatic disease is often severe and refractory to systemic opioids. Intrathecal drug delivery systems provide targeted analgesia with fewer systemic effects but carry risks of device-related infection that often require explantation.

CASE REPORT: A 55-year-old man with extensive-stage small cell lung cancer with hepatic, spinal, and brain metastases presented with intractable right upper quadrant and thoracolumbar pain despite high-dose opioids. Intrathecal hydromorphone pump implantation produced 80% to 90% pain reduction and improved function. Six weeks later, he developed methicillin-sensitive Staphylococcus aureus bacteremia with lumbar wound dehiscence and serous drainage. A multidisciplinary salvage strategy, including surgical washout, debridement, negative-pressure wound therapy, and intravenous antibiotics, was pursued, preserving the device and maintaining effective analgesia.

CONCLUSIONS: In carefully selected patients, salvage of an infected intrathecal pain pump may be feasible while maintaining critical pain control.

KEYWORDS: Intrathecal drug delivery system, cancer pain, case report, device infection, intrathecal hydromorphone, intrathecal pain pump, methicillin-sensitive Staphylococcus aureus bacteremia, small cell lung cancer, wound dehiscence