Case presentation
A 28-year-old woman was transferred for febrile disorder of
consciousness. She presented with intense headaches, vomiting without
any notion of convulsion. She was well vaccinated with Bacillus Calmette
and Geurin. There was no known history of tuberculosis infection in her
family. She had undergone spinal anaesthesia for a caesarean section 4
days before the onset of her symptoms. The physical examination revealed
a Glasgow score of 13 out of 15 and meningeal stiffness. The patient has
no spontaneous or provoked cerebrospinal fluid rhinorrhea, she had a
good oral condition, the sinus pressure points were unremarkable, no
oculomotor paralysis, no mydriasis, no purpura, the lungs examination
were unremarkable, no palpable superficial lymph nodes. The rest of the
physical examination was unremarkable. The complete blood count showed a
haemoglobin level of 12 g/dL (13.5-17.5 g/dl), a white blood cells count
of 16.5 G/L (5-10 G/L), with predominant neutrophilic polynuclear cells
(86%), a platelet count of 610 G/L (150-400 G/L). The C-reactive
protein was 96 mg/L (<6 mg/l). The creatinine was 100 µmol/L
(65.4-119.3 µmol/L). The rapid diagnostic test for malaria (RDT combo
HRP2 pLDH ) was negative, as was HIV serology. The brain CT scan
was normal and showed no contraindication to lumbar puncture
(Fig. 1 ). Magnetic resonance imaging (MRI) of the lumbar spine
showed no epidural abscess or osteomyelitis (Fig. 2 ). The
cerebrospinal fluid (CSF) examination showed a purulent and hypertensive
fluid with leukocytes at 16,560/mm3 (<5 cells/µl) with
predominant neutrophilic polynuclear cells (84%), a proteinorachy at
1g/L (<0.45 g/L) and a glycorachy at 2,88 mmol/L
(>50% glycemia); direct examination found pyocyanic
bacteria and the culture was positive for Pseudomonas aeruginosasensitive to ceftazidime, cefoperazone, imipenem, amikacin and
ciprofloxacin. The patient was diagnosed with post-spinal anesthesia
nosocomial meningitis with Pseudomonas aeruginosa. She received
cefoperazone injection 2 grams every 12 hours combined with
ciprofloxacin injection 400 milligrams every 08 hours for 3 weeks. A
control lumbar puncture was performed before the end of the treatment
and showed a normal CSF. The evolution was favorable with a recovery
without sequelae and the neurological examination before discharge was
good with a normal consciousness and disappearance of meningeal
syndrome. During her hospitalization and after the treatment, the
patient and her family were delighted with the care she received and was
optimistic about the outcome of her condition.