A 46-year-old male, with no relevant personal history, diagnosed with umbilical hernia and admitted for surgical correction.
No antibiotic prophylaxis was considered necessary.
The preoperative study showed no changes and it was decided to administer subarachnoid anesthesia. After preparation with povidone 05% solution (Betadine® Subarachnoid needle, Meda Pharma Saurro MG) was performed under aseptic conditions.
The intervention was uneventful and the patient was admitted to the post-anesthetic recovery unit (PACU) for postoperative control.
Due to the delay in the recovery of lower limb mobility, it was decided to transfer the patient to the resuscitation unit.
Eighteen hours later she began with severe frontal headache, followed by nausea, vomiting, photophobia, fever of 38oC, neck stiffness and low back pain.
In the general analysis leukocytosis with left shift (21,000 leukocytes, 90% neutrophils) stood out.
Lumbar puncture was performed with turbid cerebrospinal fluid (CSF) output with 4,100 cells/mm2, 95% polymorphonuclear, 882 mg/dl protein and 34 mg/dl glucose.
With the diagnosis of meningitis began treatment with dexamethasone, vancomycin and cefepime.
The antigen detection in the L.C.R. was negative, as well as the GRAM and culture.
The evolution was satisfactory; the symptoms disappeared within eight hours of treatment initiation, and the patient remained afflicted until he was transferred to the ward.
Antibiotic treatment was completed for ten days, despite the absence of germs in the L.C.R. She was discharged with complete resolution of the condition and without neurological sequelae.
