Meningitis after a combined spinal epidural anesthesia: A case report.

The incidence of post-dural puncture meningitis is very low. A 44-year-old patient developed a fever (38degrees C, headache, neck stiffness, nausea, and vomiting after combined spinal epidural (CSE) anesthesia and surgery for closed reduction and internal fixation (CRIF) with intramedullary (IM) nailing, tibia, Rt. With a preliminary diagnosis of bacterial meningitis, empiric broad spectrum antimicrobial treatment was immediately started after cerebrospinal fluid (CSF) sampling. The CSF was clear and revealed a white blood cell count, protein, glucose, and pressure of 146/micrometer, 225 mg/dl, 48 mg/dl (serum 151 mg/dl), and 26 cmH2O, respectively. The CSF stain and culture were negative. Considering the injection of preventive antibiotics before CSE anesthesia, partially treated bacterial meningitis was suspected. Four weeks later, clinical symptoms had improved before the patient was discharged.