Lee YW, Yoo B, Lim YH. Varicella-zoster virus meningitis after spinal anesthesia: A case report. World J Clin Cases 2022; 10(25): 9127-9131 [PMID: 36157639 DOI: 10.12998/wjcc.v10.i25.9127]
Corresponding Author of This Article
Byunghoon Yoo, MD, PhD, Associate Professor, Department of Anesthesiology and Pain Medicine, College of Medicine, Inje University, Sanggye Paik Hospital, 1342, Dongil-ro, Nowon-gu, Seoul 01757, South Korea. twowind.yoo@gmail.com
Research Domain of This Article
Anesthesiology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Sep 6, 2022; 10(25): 9127-9131 Published online Sep 6, 2022. doi: 10.12998/wjcc.v10.i25.9127
Varicella-zoster virus meningitis after spinal anesthesia: A case report
Ye-Won Lee, Byunghoon Yoo, Yun Hee Lim
Ye-Won Lee, Byunghoon Yoo, Yun Hee Lim, Department of Anesthesiology and Pain Medicine, College of Medicine, Inje University, Sanggye Paik Hospital, Seoul 01757, South Korea
Author contributions: Yoo B and Lim YH designed the case report; Lee YW performed the anesthesia and wrote the original paper; Lee YW and Yoo B reviewed the literature; All authors revised the manuscript and approved the final version.
Informed consent statement: Informed written consent was obtained prior to treatment and for the publication of this report.
Conflict-of-interest statement: All authors report no relevant conflict of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Byunghoon Yoo, MD, PhD, Associate Professor, Department of Anesthesiology and Pain Medicine, College of Medicine, Inje University, Sanggye Paik Hospital, 1342, Dongil-ro, Nowon-gu, Seoul 01757, South Korea. twowind.yoo@gmail.com
Received: April 14, 2022 Peer-review started: April 14, 2022 First decision: June 16, 2022 Revised: June 27, 2022 Accepted: July 22, 2022 Article in press: July 22, 2022 Published online: September 6, 2022 Processing time: 134 Days and 7.8 Hours
Abstract
BACKGROUND
Headache is a common complication of regional anesthesia. The treatment of post spinal anesthesia headache varies depending on the cause. Although meningitis is rare, it can cause significant harm to the patient. Post dural puncture headache and septic meningitis are the most commonly suspected causes of post spinal anesthesia headache; however, other causes should also be considered.
CASE SUMMARY
A 69-year-old woman was scheduled for varicose vein stripping surgery under spinal anesthesia. The procedure was performed aseptically, and surgery was completed without any complications. After 4 d, the patient visited the emergency room with complaints of headache, nausea, and anorexia. Clinical examination revealed that the patient was afebrile. Considering the history of spinal anesthesia, post dural puncture headache and septic meningitis was initially suspected, and the patient was treated with empirical antibiotics. Subsequently, varicella-zoster virus PCR test result was positive, and all other test results were negative. The patient was diagnosed with meningitis caused by varicella-zoster virus and was treated with acyclovir for 5 d. The headache improved, and the patient was discharged without any problems.
CONCLUSION
Viral meningitis due to virus reactivation may cause headache after regional anesthesia. Therefore, clinicians should consider multiple etiologies of headache.
Core Tip: Aseptic meningitis is a rare complication of spinal anesthesia. Herein, we present the case of a patient who developed aseptic meningitis due to reactivation of the varicella-zoster virus after spinal anesthesia for varicose vein stripping surgery. The patient was diagnosed with meningitis caused by varicella-zoster virus based on positive PCR test results and was treated with acyclovir for 5 d. The headache improved, and the patient was discharged without any sequelae. This case highlights the importance of differential diagnosis of post spinal anesthesia headache because viral meningitis due to virus reactivation may cause headache after regional anesthesia.
