Meningitis after a combined spinal epidural anesthesia: A case report

Area of Science:

• Anesthesiology
• Infectious Diseases
• Neurosurgery

Background:

• Post-dural puncture meningitis is a rare but serious complication.
• Combined spinal epidural (CSE) anesthesia is frequently used for orthopedic procedures.
• Early diagnosis and treatment are crucial for favorable outcomes.

Purpose of the Study:

• To report a case of suspected partially treated bacterial meningitis after CSE anesthesia.
• To discuss the diagnostic challenges and management of this rare complication.

Main Methods:

• A case report of a 44-year-old patient who developed meningitis symptoms post-CSE anesthesia.
• Cerebrospinal fluid (CSF) analysis including cell count, protein, glucose, and culture.
• Empiric broad-spectrum antimicrobial treatment initiated.
• Clinical monitoring and outcome assessment.

Main Results:

• The patient presented with fever, headache, and neck stiffness post-CSE anesthesia and surgery.
• CSF analysis showed elevated white blood cells and protein, but negative Gram stain and culture.
• Partially treated bacterial meningitis was suspected due to pre-anesthesia antibiotics.
• Clinical symptoms improved with continued antimicrobial therapy.

Conclusions:

• While rare, bacterial meningitis should be considered in patients with suggestive symptoms after neuraxial anesthesia.
• Negative CSF cultures may occur in partially treated cases.
• Prompt empiric antibiotic treatment is essential for managing suspected meningitis.