Eosinophilic meningitis and pseudomeningocele complicating postoperative course in a case of posterior fossa meningioma: A case report and review of literature

Abstract

Introduction: Eosinophilic meningitis is diagnosed by the presence of at least 10% eosinophils in CSF (Cerebrospinal fluid). Aetiological factors may be the use of collagen based dural substitutes, floseal, bioglue, silastic reservoir, or parasitic or fungal infections. Case report: A 37 year-old female with a posterior fossa mass, presented with herniation. She underwent emergency surgery and complete removal of the meningioma. An Ommaya reservoir was placed in the occipital region for emergency CSF access, should the need arise. She was discharged 10 days after the surgery.On post-operative day 10, she had a pseudomeningocoele and surgical site CSF discharge. CSF showed no evidence of infection. No growth of any organism was seen on culture. No fever. Moderate leukocytosis and reduced glucose was seen in lumbar CSF. Examination of CSF from ommaya had similar findings. Broad spectrum antibiotic cover was given and serial CSF examinations were done to look for the response. No hydrocephalus was seen on CT scan (post operative).CSF re-examinations in view of persistence of pseudomeningocoele showed eosinophilic pleocytosis (over 80 %). Peripheral blood microscopy revealed eosinophilia. She responded to steroids initially; however on tapering there was a recurrence of the pseudomeningocele with worsening of the CSF picture. The Ommaya reservoir was then removed and steroids were reintroduced. The pseudomeningocoele subsided within a week and has not recurred till date. Conclusion: Eosinophilic meningities is a diagnosis of exclusion. Silastic reservoirs can cause allergic reactions. Possibility of such reactions should be kept in mind while treating patients with resistant postoperative meningitis with pseudomeningocoele.

Keywords

• Chemical meningitis
• Eosinophilia
• Allergic reactions
• Silastic reservoir