Drug-induced aseptic meningitis after an interlaminar lumbar epidural steroid injection.

IF 2.7 3区医学 Q2 ANESTHESIOLOGY Pain Practice Pub Date : 2024-04-01 Epub Date: 2023-12-18 DOI:10.1111/papr.13333

Trong P Nguyen, Ishu Kant, Alec Cartagena, Jung H Kim

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Abstract

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.

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腰椎硬膜外类固醇层间注射后药物诱发无菌性脑膜炎。

背景：本病例报告描述了一例腰椎硬膜外类固醇层间注射后药物诱发无菌性脑膜炎的罕见病例：一名 74 岁的女性患者在进行 L4-L5 层间腰椎硬膜外类固醇注射术后第三天因发热、恶心和呕吐来到急诊室。患者之前曾多次接受腰椎硬膜外腔注射，均未出现并发症，使用的药物也完全相同，包括 1%利多卡因、碘海醇造影剂、甲基强的松龙（Depo-medrol）和生理盐水。相关化验包括白细胞 15000 个/μL。腰椎核磁共振成像显示患者患有 L4-S1 无菌性蛛网膜炎。两次镓和T-99骨扫描证实没有感染过程。几个月后，患者再次入院，在重复腰部硬膜外注射类固醇后，出现了类似的症状和住院过程。腰椎磁共振成像和脑脊液检查证实为无菌性脑膜炎：结论：该患者因无菌性脑膜炎反复入院，很可能是由于手术过程中使用的药物刺激了脑膜层。

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来源期刊

Pain Practice ANESTHESIOLOGY-CLINICAL NEUROLOGY

CiteScore

5.60

自引率

3.80%

发文量

审稿时长

6-12 weeks

期刊介绍： Pain Practice, the official journal of the World Institute of Pain, publishes international multidisciplinary articles on pain and analgesia that provide its readership with up-to-date research, evaluation methods, and techniques for pain management. Special sections including the Consultant’s Corner, Images in Pain Practice, Case Studies from Mayo, Tutorials, and the Evidence-Based Medicine combine to give pain researchers, pain clinicians and pain fellows in training a systematic approach to continuing education in pain medicine. Prior to publication, all articles and reviews undergo peer review by at least two experts in the field.