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Abstract Details

Characteristics of patients with meningitis after lumbar epidural steroid injection
Infectious Disease
Infectious Disease Posters (7:00 AM-5:00 PM)
085

To assess the clinical, laboratory, and radiologic features of meningitis after lumber epidural steroid injection (ESI) that is distinguished from acute bacterial meningitis (ABM).

Various complications can develop after lumbar ESI. Meningitis after ESI (M-ESI) is considered as ABM or acute chemical meningitis (ACM), but its characteristics remain undetermined. 

Among the total of 815 patients with meningitis, those with a history of lumbar ESI within a week before the diagnosis of meningitis (Group 1) and those with ABM in which the pathogenic organism was identified (Group 2) were enrolled. Detailed medical records were reviewed retrospectively.
Forty-two patients (7 patients in Group 1 and 35 patients in Group 2) were enrolled in the study. The patients in Group 1 developed symptoms shortly after the procedure (median 4 hours), and the symptoms improved abruptly within a day after the treatment. Radiologically, pneumocephalus were more frequent in group 1 (p=0.003). There was no difference between the two groups in cerebrospinal fluid (CSF) parameters. In the univariate analysis, the changes of WBC count in blood (ΔWBC) a day after the treatment in Group 1 were different from those in Group 2 (median, -15.16% versus 15.87, p=0.009). Serum C-reactive protein (CRP) and procalcitonin were significantly lower in Group 1 (p=0.034 and p=0.001). Group 1 showed a marked decrease in the level of CRP (ΔCRP) immediately after the treatment, whereas the level of CRP increased in Group 2 (p <0.001). However, there was no independent factor that distinguishing M-ESI from BM in the multivariate logistic regression analysis.

The initial clinical manifestations and the CSF findings of M-ESI was similar to those of ABM. However, several distinctive features suggesting ACM were observed. Further studies on differentiating ABM and ACM in M-ESI could be important for preventing unnecessary use of antibiotics and prolonged hospitalization.
Authors/Disclosures

PRESENTER 		No disclosure on file
No disclosure on file
No disclosure on file
Seung-Han Lee, MD, PhD (Chonnam National University Hospital) Dr. Lee has nothing to disclose.
Tai-Seung Nam, MD (Chonnam National University Hospital) No disclosure on file