Chemical meningitis after cervical transforaminal epidural steroid injection: a case report

Area of Science:

• Neurology
• Pharmacology

Background:

• Cervical transforaminal steroid injections are common procedures for managing neck pain.
• Potential complications, though rare, require careful consideration and prompt recognition.

Observation:

• A 49-year-old male developed acute meningitis symptoms, including severe headache and neck stiffness, 2.5 hours post-cervical transforaminal steroid injection.
• Cerebrospinal fluid (CSF) analysis revealed a significantly elevated white blood cell count (7106 cells/µL), mimicking bacterial meningitis.
• The absence of organisms on CSF Gram stain and the rapid symptom onset post-injection were key diagnostic factors.

Findings:

• The patient was diagnosed with chemical meningitis, a rare adverse event associated with epidural injections.
• Symptomatic treatment with analgesics resulted in complete resolution of headache and neck stiffness within three days.

Implications:

• This case underscores the importance of recognizing chemical meningitis as a potential complication following cervical transforaminal steroid injections.
• Clinicians should maintain a high index of suspicion for chemical meningitis in patients presenting with acute neurological symptoms post-procedure.
• Awareness of this complication can lead to timely diagnosis and appropriate management, preventing unnecessary aggressive treatments for presumed bacterial meningitis.