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Drug-induced aseptic meningitis after an interlaminar lumbar epidural steroid injection
Trong P Nguyen1, Ishu Kant1, Alec Cartagena1
1Department of Anesthesia, Perioperative and Pain Medicine, Mount Sinai West-Morningside Hospitals, New York City, New York, USA.
Background:
This case report describes a rare instance of drug-induced aseptic meningitis after an interlaminar lumbar epidural steroid injection.
Case Presentation:
A 74 year-old female patient presented to the ED post-procedure day three after an L4-L5 interlaminar lumbar epidural steroid injection with fever, nausea, and vomiting. The patient had previously undergone numerous lumbar epidurals without complications and used identical medications, which included 1% lidocaine, iohexol contrast, methylprednisolone (Depo-medrol), and normal saline. Pertinent labs included a WBC of 15,000 cells/μL. Lumbar MRI revealed L4-S1 aseptic arachnoiditis. Two bone scans with Gallium and T-99 confirmed no infectious process. The patient then had a second admission months later with similar presenting symptoms and hospital course after repeating the lumbar epidural steroid injection. Lumbar MRI and CSF studies confirmed aseptic meningitis.
Conclusion:
This patient's repeated admissions from aseptic meningitis were likely caused by irritation of the meningeal layers from a medication used during the procedure.
Insights
A rare case of drug-induced aseptic meningitis occurred after an interlaminar lumbar epidural steroid injection. This condition, characterized by meningeal irritation, recurred upon repeat procedures, highlighting potential medication risks.
Area of Science:
- Neurology
- Pharmacology
- Radiology
Background:
- Aseptic meningitis is a rare but serious complication.
- Epidural steroid injections are commonly used for pain management.
- Identifying drug-induced causes is crucial for patient safety.
Observation:
- A 74-year-old female developed aseptic meningitis post-lumbar epidural steroid injection.
- Symptoms included fever, nausea, and vomiting.
- Aseptic arachnoiditis was confirmed via MRI, with no infectious process identified.
Findings:
- The patient experienced recurrent aseptic meningitis after a repeat epidural steroid injection.
- Cerebrospinal fluid (CSF) studies confirmed aseptic meningitis.
- Methylprednisolone, lidocaine, and iohexol contrast were used in the procedure.
Implications:
- Medications used in epidural steroid injections can potentially cause drug-induced aseptic meningitis.
- This case underscores the importance of considering medication-induced complications.
- Further investigation into the specific agents causing meningeal irritation is warranted.
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