Post-Spinal Meningitis and Autoimmune Encephalopathy: A case report / 대한마취과학회지

ABSTRACT

Meningitis and subsequent autoimmune encephalopathy after spinal anesthesia has never been reported. A 39-year-old patient developed dizziness, headache, fever (38 degrees C), drowsiness, and neck stiffness 3 days after uneventful and uncomplicated spinal anesthesia and surgery for total hip replacement. Under the impression of bacterial meningitis, antibiotic therapy was immediately started after CSF sampling. However, the CSF was clear and showed an inappropriate profile for bacterial meningitis. CSF stain and culture, an antibody study, and polymerase chain reaction for pathogens were negative. Therefore, aseptic meningitis was suspected. Eleven days later, clinical symptoms and laboratory findings had improved to near normal, but unexpected visual and phonation difficulties, lower leg paralysis, and myotonia developed. Brain MRI revealed autoimmune encephalopathy of unknown etiology, and antithyroglobulin and antimicrosomal antibody were high. Steroid therapy was started and symptoms improved, but mild sequela remain.