Varicella-zoster virus meningitis after spinal anesthesia: A case report

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.

Keywords: Aseptic meningitis; Headache; Regional anesthesia; Spinal anesthesia; Varicella zoster virus infection; Case report

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.