A 41-year-old man presented with postcervical traumatic complete
quadriparesis under intrathecal
baclofen therapy (ITB) for refractory spasticity. Less than 24 h after having his
baclofen pump substituted, he develops
hyperthermia,
seizures, cognitive depression, acute hypoxaemic
respiratory failure and cardiovascular instability leading to
mechanical ventilation and vasopressor support. He was transferred to an intensive care unit with diagnosis of community-acquired
pneumonia leading to
septic shock. He evolved with progressive clinical worsening and multisystem organ failure and
cardiac arrest in non-shockable rhythm (pulseless electrical activity)--4 min
resuscitation with return of spontaneous circulation. Considering the possible diagnosis of
baclofen withdrawal syndrome and, in suspicion of ITB delivery disruption, the
catheter system was surgically explored and a leaking tubule attachment was found. Despite aggressive cardiovascular, respiratory and renal support
therapy, clinical improvement occurred only after restoration of intrathecal
drug delivery. He was discharged from the hospital after 56 days, having returned to baseline status.