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Characteristics of patients with meningitis after lumbar epidural steroid injection

To investigate the clinical, laboratory, and radiological features of meningitis after lumbar epidural steroid injection (M-ESI) without accompanying spinal infection, data of patients with meningitis admitted between January 2014 and December 2021 in a single center were retrospectively reviewed. A...

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Autores principales: Kang, You-Ri, Nam, Tai-Seung, Kim, Byeong C., Kim, Jae-Myung, Cho, Soo Hyun, Kang, Kyung Wook, Choi, Kang-Ho, Kim, Joon-Tae, Choi, Seong-Min, Lee, Seung-Han, Park, Man-Seok, Kim, Myeong-Kyu
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9794205/
https://www.ncbi.nlm.nih.gov/pubmed/36595762
http://dx.doi.org/10.1097/MD.0000000000032396
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author Kang, You-Ri
Nam, Tai-Seung
Kim, Byeong C.
Kim, Jae-Myung
Cho, Soo Hyun
Kang, Kyung Wook
Choi, Kang-Ho
Kim, Joon-Tae
Choi, Seong-Min
Lee, Seung-Han
Park, Man-Seok
Kim, Myeong-Kyu
author_facet Kang, You-Ri
Nam, Tai-Seung
Kim, Byeong C.
Kim, Jae-Myung
Cho, Soo Hyun
Kang, Kyung Wook
Choi, Kang-Ho
Kim, Joon-Tae
Choi, Seong-Min
Lee, Seung-Han
Park, Man-Seok
Kim, Myeong-Kyu
author_sort Kang, You-Ri
collection PubMed
description To investigate the clinical, laboratory, and radiological features of meningitis after lumbar epidural steroid injection (M-ESI) without accompanying spinal infection, data of patients with meningitis admitted between January 2014 and December 2021 in a single center were retrospectively reviewed. Among them, patients with a recent history of lumbar ESI were identified, and their medical records were collected. Patients with concomitant infections other than meningitis, including spinal epidural abscess, were excluded. Seven patients with M-ESI were identified. All patients presented with headache and fever without focal neurological deficits, and headache developed shortly after a procedure (median, 4 hours). Cerebrospinal fluid (CSF) analysis showed neutrophilic pleocytosis (median, 6729/μL), elevated protein level (median, 379.1 mg/dL), decreased ratio of CSF glucose to serum glucose (median, 0.29), and elevated lactate level (median, 8.64 mmol/L). Serum level of C-reactive protein was elevated in 6, but serum procalcitonin level was within normal range. No causative pathogen was identified in the microbiological studies. The most frequent radiologic feature was sulcal hyperintensity on fluid-attenuated inversion recovery images (57%), followed by pneumocephalus (43%). Symptoms subsided in a short period (median, 1 day) after initiating treatment with antibiotics and adjuvant intravenous corticosteroids. None of the patients experienced neurological sequelae. Though the cardinal symptoms and CSF findings of M-ESI were comparable to those of bacterial meningitis, M-ESI seems to have distinctive characteristics regarding the clinical course, laboratory parameters, and pneumocephalus.
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spelling pubmed-97942052022-12-28 Characteristics of patients with meningitis after lumbar epidural steroid injection Kang, You-Ri Nam, Tai-Seung Kim, Byeong C. Kim, Jae-Myung Cho, Soo Hyun Kang, Kyung Wook Choi, Kang-Ho Kim, Joon-Tae Choi, Seong-Min Lee, Seung-Han Park, Man-Seok Kim, Myeong-Kyu Medicine (Baltimore) 5300 To investigate the clinical, laboratory, and radiological features of meningitis after lumbar epidural steroid injection (M-ESI) without accompanying spinal infection, data of patients with meningitis admitted between January 2014 and December 2021 in a single center were retrospectively reviewed. Among them, patients with a recent history of lumbar ESI were identified, and their medical records were collected. Patients with concomitant infections other than meningitis, including spinal epidural abscess, were excluded. Seven patients with M-ESI were identified. All patients presented with headache and fever without focal neurological deficits, and headache developed shortly after a procedure (median, 4 hours). Cerebrospinal fluid (CSF) analysis showed neutrophilic pleocytosis (median, 6729/μL), elevated protein level (median, 379.1 mg/dL), decreased ratio of CSF glucose to serum glucose (median, 0.29), and elevated lactate level (median, 8.64 mmol/L). Serum level of C-reactive protein was elevated in 6, but serum procalcitonin level was within normal range. No causative pathogen was identified in the microbiological studies. The most frequent radiologic feature was sulcal hyperintensity on fluid-attenuated inversion recovery images (57%), followed by pneumocephalus (43%). Symptoms subsided in a short period (median, 1 day) after initiating treatment with antibiotics and adjuvant intravenous corticosteroids. None of the patients experienced neurological sequelae. Though the cardinal symptoms and CSF findings of M-ESI were comparable to those of bacterial meningitis, M-ESI seems to have distinctive characteristics regarding the clinical course, laboratory parameters, and pneumocephalus. Lippincott Williams & Wilkins 2022-12-23 /pmc/articles/PMC9794205/ /pubmed/36595762 http://dx.doi.org/10.1097/MD.0000000000032396 Text en Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY) (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle 5300
Kang, You-Ri
Nam, Tai-Seung
Kim, Byeong C.
Kim, Jae-Myung
Cho, Soo Hyun
Kang, Kyung Wook
Choi, Kang-Ho
Kim, Joon-Tae
Choi, Seong-Min
Lee, Seung-Han
Park, Man-Seok
Kim, Myeong-Kyu
Characteristics of patients with meningitis after lumbar epidural steroid injection
title Characteristics of patients with meningitis after lumbar epidural steroid injection
title_full Characteristics of patients with meningitis after lumbar epidural steroid injection
title_fullStr Characteristics of patients with meningitis after lumbar epidural steroid injection
title_full_unstemmed Characteristics of patients with meningitis after lumbar epidural steroid injection
title_short Characteristics of patients with meningitis after lumbar epidural steroid injection
title_sort characteristics of patients with meningitis after lumbar epidural steroid injection
topic 5300
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9794205/
https://www.ncbi.nlm.nih.gov/pubmed/36595762
http://dx.doi.org/10.1097/MD.0000000000032396
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