Introduction:

Healthcare associated meningitis occurs in patients exposed to invasive procedures with dural puncture or who carry intrathecal devices. Meningitis associated to spinal anesthesia has a low frequency, 0-2/10,000 cases, though is thought to be an underreported and underdiagnosed entity.

Materials and methods:

This is a case report of a patient admitted to the Neurological Institute of the Hospital de Clinicas in Montevideo, Uruguay. The team conducted a literature research trough pubmed using the terms: “meningitis”, “health care associated”, “spinal anesthesia”, and “meningitis post dural puncture”. We also reviewed updated clinical practice guidelines on health-care associated meningitis.

Case presentation:

We report the case of a 24 years old patient who underwent inguinal hernia surgery with spinal anesthesia, presenting with headache, vomits and fever 24hs later. 72hs hours later the patient demonstrated bilateral compromise of oculomotor nerve and right abducens nerve. Analysis of cerebrospinal fluid (CSF) confirmed the diagnosis of healthcare associated meningitis. Antibiotic therapy was initiated with excellent response. No germ was isolated on blood and CSF cultures.

Conclusion:

Health-care associated meningitis is an emergency that requires prompt diagnosis and treatment for good outcomes. Conventional techniques not always allow to reach microbiological diagnosis, as in the case reported above. We emphasize on the need to hold strict asepsia and to use facial protection masks when executing spinal puncture to prevent this potentially mortal complication.

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