Takotsubo Cardiomyopathy in a Patient with Intrathecal Baclofen Withdrawal Despite Gradual Weaning: A Case Report

Case Diagnosis: A 64 year-old female patient with multiple sclerosis (MS) who presented to the Emergency Department (ED) with wound dehiscence and developed Takotsubo cardiomyopathy after baclofen pump weaning.

Case Description or Program Description: When the patient presented to the ED, her intrathecal baclofen pump, which was placed for management of MS, was exposed due to wound dehiscence. The patient had discoloration, odorous drainage, and pain at the surgical site. The patient was started on antibiotics for possible infection. Explantation of the pump was delayed to gradually wean the intrathecal baclofen dose and reduce the possibility of withdrawal. 1 day after she presented to the ED, the patient’s intrathecal baclofen was reduced from the starting rate of 1,227.2 mcg/day by 25%. Her dosage of oral baclofen was increased to mitigate the risk of withdrawal. After 2 additional days, the intrathecal rate was further reduced by 25%, which was followed by another 25% reduction 3 days later. At this point, echocardiogram revealed significantly decreased left ventricular systolic function, suggestive of Takotsubo cardiomyopathy.

Setting: Tertiary care hospital.

Assessment/Results: The patient’s multi-week hospital course was eventually complicated by sepsis. The patient was placed on palliative care and died in the hospital.

Discussion (relevance): Common symptoms of intrathecal baclofen withdrawal include hyperthermia, hypertension, tachycardia, seizures, and altered mental status. There has been a previous report of a patient who developed Takotsubo cardiomyopathy after an unintentional and abrupt cessation of intrathecal baclofen due to the distal extremity of the catheter moving out of the intrathecal space. To our knowledge, this is the first reported case of Takotsubo cardiomyopathy in a patient who was weaned off of intrathecal baclofen over several days.

Conclusions: Even when weaned off of intrathecal baclofen over multiple days, patients should be monitored for the increased risk of developing Takotsubo cardiomyopathy.