A Case of Chemical Meningitis Induced by Intrathecal Bupivacaine Injection

Abstract

Background: Iatrogenic meningitis after spinal anesthesia is a rare condition. Most cases of iatrogenic meningitis have a bacterial etiology; however, there are a few reports of chemical meningitis associated with intrathecal administration of bupivacaine. Case Report: A 74-year-old man underwent cystoscopy, with anesthesia by intrathecal bupivacaine hydrochloride injection. Two hours post-procedurally, he complained of a severe headache and his mental status subsequently deteriorated from alertness to confusion. Cerebrospinal fluid examination on the day of admission showed an increase in cell count (841/mm 3 ; polymorphonuclear 78%: mononuclear 10%) and total protein (460 mg/dL). His clinical findings and laboratory abnormalities were consistent with the diagnosis of bupivacaine-induced chemical meningitis, rather than the bacterial meningitis. Conclusion: We report a case of chemical meningitis after spinal anesthesia with bupivacaine. Differential diagnosis should include chemical meningitis in cases of meningitis after spinal anesthesia.