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Drug-Induced Aseptic Meningitis Following Spinal Anesthesia

Ricardo Paquete Oliveira1, Mafalda Teixeira1, Sofia Cochito2

  • 1Serviço de Medicina IV, Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal.

European Journal of Case Reports in Internal Medicine
|February 5, 2020
PubMed

Insights

Drug-induced aseptic meningitis (DIAM) is a rare complication following spinal anesthesia. Early recognition and stopping antibiotics upon negative cerebrospinal fluid cultures lead to rapid recovery without sequelae.

Area of Science:

  • Anesthesiology
  • Neurology
  • Infectious Diseases

Background:

  • Meningitis is an uncommon complication of spinal anesthesia.
  • Drug-induced aseptic meningitis (DIAM) is an even rarer complication.
  • DIAM can mimic bacterial meningitis, complicating diagnosis and treatment.

Purpose of the Study:

  • To present two cases of DIAM following spinal anesthesia.
  • To highlight the diagnostic challenges and management of DIAM.
  • To emphasize the importance of recognizing DIAM to avoid unnecessary antibiotic use.

Main Methods:

  • Case report of two patients who developed DIAM after spinal anesthesia.
  • Clinical presentation with meningitis symptoms.
  • Cerebrospinal fluid (CSF) analysis and empirical antibiotic treatment.

Main Results:

  • Both patients presented with meningitis symptoms post-spinal anesthesia.
  • Initial CSF analysis could not rule out bacterial meningitis, leading to empirical antibiotics.
  • Negative CSF cultures for bacteria and viruses, followed by prompt antibiotic cessation, resulted in rapid recovery without neurological deficits.

Conclusions:

  • DIAM should be considered in patients with meningitis symptoms after spinal anesthesia.
  • Clinical and CSF findings may not differentiate DIAM from bacterial meningitis.
  • Negative CSF cultures and rapid clinical improvement confirm DIAM, supporting the cessation of antibiotics.
Keywords:
Aseptic meningitisbupivacainedrug-induced aseptic meningitisropivacaine

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