Chemical meningitis is a rare, noninfectious complication of intrathecal manipulation. The common complaint of back pain may result in the need for neurosurgical procedures or placement of intrathecal pain pumps, which may give rise to this complication.
Chemical meningitis, a specific type of drug‐induced aseptic meningitis resulting from intrathecal injection, is a rare outcome that may be the result of drug solutions or other equipment utilized in neurosurgical procedures.1 It has been theorized to be caused by a hypersensitivity reaction or by direct meningeal irritation.2, 3, 4 It is characterized by lack of infectious etiology and by improvement in a few days without use of antibiotics. CSF (cerebrospinal fluid) analysis reveals pleocytosis typically of polymorphonuclear predominance but may be of lymphocytic or eosinophilic predominance as well; additionally, the CSF protein is usually elevated while the glucose level remains within normal limits.1
This report is of a patient diagnosed with chemical meningitis as a result of hydromorphone via an intrathecal pain pump who was diagnosed by process of exclusion based on CSF findings and cultures.