Aseptic Meningitis Complicating lotrolan Myelography

The patient was a 50-year-old woman who had had frequency of urination and numbness of the left side of the trunk for a few years. Neurologic examination showed slight anisocoria (right > left), asymmetry of muscle stretch reflex (right > left) in both upper and lower extremities, hypalgesia and thermohypesthesia of the left side of the trunk, and hypopallesthesia in the right lower extremity. MR imaging showed a Chiari I anomaly and formation of a syrinx from the C3 to the T12 level. Before instillation of 8 ml of iotrolan (lsovist, Schering AG, Berlin; 200 mg lfml), the patient did not have any symptoms of meningitis, and examination of the CSF did not show any abnormalities. CT myelography showed swelling of the cervical cord. The morning after myelography, the patient had a headache and vomiting, a body temperature of 39.6°C, and a stiff neck. A lumbar puncture was done, and examination of the CSF showed a WBC count of 4261 /ltl with 70% polymorphonuclear leukocytes. The protein level was 231 mgjdl , and the glucose level was 31 mgfdl. We considered bacterial meningitis at first and administered antibiotics; however, we also considered aseptic meningitis associated with myelography because these two types of meningitis are indistinguishable both clinically and on CSF examination. Serial cultures of CSF and blood obtained before and 2, 5, and 9 days after antibiotic therapy was started were all negative. Seven days after myelography, the patient was afebrile and symptom-free. She recovered completely without any sequelae.