Chemical meningitis related to intrathecal corticosteroid therapy

A patient developed symptomatic lymphocytic meningitis with hypoglycorrhachia after two intrathecal injections of methylprednisolone acetate. Chills, fever, and confusion occurred ten days after the second injection, and were brief in duration. There were no obvious sequelae. Hypoglycorrhachia secondary to intrathecal steroids has not been previously reported. Steroid-induced chemical meningitis should be considered in any patient who develops CNS symptoms and an abnormal CSF after receiving intrathecal steroids. Obviously, the more common causes of lymphocytic meningitis with or without hypoglycorrhachia must be excluded.