Drug-Induced Aseptic Meningitis Following Spinal Anesthesia

  • Ricardo Paquete Oliveira Serviço de Medicina IV, Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal
  • Mafalda Teixeira Serviço de Medicina IV, Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal
  • Sofia Cochito Departamento de Pediatria, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, EPE Clínica Universitária de Pediatria, Faculdade de Medicina, Universidade de Lisboa. Lisboa, Portugal
  • Ana Furtado Serviço de Medicina IV, Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal
  • Bruno Grima Serviço de Medicina IV, Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal
  • José Delgado Alves Serviço de Medicina IV, Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal

Keywords

Aseptic meningitis, drug-induced aseptic meningitis, ropivacaine, bupivacaine

Abstract

Meningitis is a very uncommon complication of spinal anesthesia, and drug-induced aseptic meningitis (DIAM) is even rarer. We present two cases of DIAM following spinal anesthesia with bupivacaine and ropivacaine, respectively. The patients presented shortly after the procedure with typical meningitis symptoms. Since CSF (cerebrospinal fluid) analysis could not initially exclude bacterial meningitis, they were started on empirical antibiotics.
CSF was subsequently found to be negative for viruses and bacteria in both cases, and antibiotics were promptly stopped. Both patients improved rapidly and without neurological sequelae. While it remains a diagnosis of exclusion, it is important to be aware of DIAM as recognition of the condition can lead to shorter admission times and avoid unnecessary use of antibiotics.

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References

  • Videira R, Ruiz-Neto P, Brandao Neto M. Post spinal meningitis and asepsis. Acta Anaesthesiol Scanda 2002;46:639–646.

  • Jolles S, Sewell W, Leighton C. Drug-induced aseptic meningitis: diagnosis and management. Drug Saf 2000;22:215–226.

  • Dubos F, Lamotte B, Bibi-Triki F, Moulin F, Raymond J, Gendrel D et al. Clinical decision rules to distinguish between bacterial and aseptic meningitis. Arch Dis Child 2006;91:647–650.

  • Moris G, Garcia-Monco J. The challenge of drug-Induced aseptic meningitis. Arch Intern Med 1999;159:1185–1194.

  • Zarrouk V, Vassor I, Bert F, Bouccara D, Kalamarides M, Bendersky N et al. Evaluation of the management of postoperative aseptic meningitis. Clin Infect Dis 2007;44:1555–1559.

  • Bihan K, Weiss N, Théophile H, Funck-Brentano C, Lebrun-Vignes B. Drug-induced aseptic meningitis: 329 cases from the French pharmacovigilance database analysis. Br J Clin Pharmacol 2019;85:240–246.

  • Ruetsch Y, Boni T, Borgeat A. From cocaine to ropivacaine: the history of local anesthetic drugs. Curr Top Med Chem 2001;1:175–182.

  • Tateno F, Sakakibara R, Kishi M, Ogawa E. Bupivacaine-induced chemical meningitis. J Neurol 2010;257:1327–1329.
  • Published: 2019-12-31

    Issue: Vol 7 No 1 (view)

    Section: Articles

    How to cite:
    Oliveira, R., Teixeira, M., Cochito, S., Furtado, A., Grima, B., & Alves, J. (2019). Drug-Induced Aseptic Meningitis Following Spinal Anesthesia. European Journal of Case Reports in Internal Medicine, 7(1). https://doi.org/https://doi.org/10.12890/2019_001334