Clostridium perfringens: A rare cause of postoperative spinal surgery meningitis

BACKGROUND Clostridium perfringens is a rare cause of central nervous system infection s, particularly meningitis. The case of a 76-year-old man who developed fat al C. perfringens meningitis after routine decompressive laminectomy for sp inal stenosis is described, CASE REPORT Twelve days after surgery the patient presented with pain and serosangiunou s drainage from the surgical incision site. A swab of the drainage revealed Gram-positive bacilli; MRI of the lumbosacral spine showed the appearance of air around the laminectomy site. The patient died within 6 hours of pres entation. Autopsy revealed acute cranial and spinal meningitis and choroid plexitis with organisms consistent with C. perfringens. CONCLUSION No significant enteral pathology or source of endogenous infection was dete rmined, suggesting postoperative wound contamination and meningeal seeding with this ubiquitous organism. Clostridial infection, although rare, should be considered in any patient with meningitis with a history of surgical in tervention. Survival with minimal neurological deficits was achieved in hal f of the previously reported cases. (C) 1999 by Elsevier Science Inc.