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.