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Epidural abscess and meningitis, a complication of spinal anesthesia in a bacteraemic patient

Manzar Zakaria1, Mujeeb-Ur-rehman Abid Butt

  • 1Combined Military Hospital, Lahore, Pakistan.

JPMA. the Journal of the Pakistan Medical Association
|September 18, 2009
PubMed

Insights

Performing a lumbar puncture (LP) in patients with bacteraemia (bacteria in the bloodstream) may lead to meningitis. This case study highlights a potential risk of LP in patients with bloodstream infections.

Area of Science:

  • Neurology
  • Infectious Diseases
  • Neurosurgery

Background:

  • Bacteraemia, or bacteria in the bloodstream, is a known risk factor for developing meningitis.
  • The potential for a lumbar puncture (LP) procedure to induce meningitis in bacteraemic patients has been debated.
  • Spinal anaesthesia is frequently used for lower limb surgeries, with bacteraemia being a potential complication in patients undergoing such procedures.

Observation:

  • A 57-year-old male with a foot infection and gangrene underwent a below-knee amputation under spinal anaesthesia.
  • Post-operatively, the patient developed backache and fever, progressing to seizures and respiratory failure.
  • Cerebrospinal fluid analysis revealed Streptococcus agalactiae meningitis, consistent with the wound culture from admission.

Findings:

  • The patient developed meningitis and an epidural abscess following a procedure performed while bacteraemic.
  • Streptococcus agalactiae was identified as the causative agent in both the wound and cerebrospinal fluid.
  • Magnetic Resonance Imaging confirmed the spinal epidural abscess.

Implications:

  • This case underscores the potential iatrogenic risk of performing lumbar punctures in patients with concurrent bacteraemia.
  • Careful consideration of bacteraemia status prior to lumbar puncture is crucial to prevent secondary meningitis.
  • Prompt diagnosis and antibiotic management are essential for favourable outcomes in meningitis and epidural abscess cases.

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