Posttraumatic Meningitis: A Rare Complication of Open Brachial Plexus Palsy

Abstract

We herein report a unique case of meningitis resulting from an open brachial plexus injury. The probable mechanism of infection, early diagnostic features that are lifesaving, and successful management are also detailed. A 27-year-old healthy man had a polytrauma, which included a subclavian vessel hematoma, an open wound in the subclavian region, and global brachial plexus palsy on the right side. The open wound was debrided and sutured primarily in the theater while all the other injuries were managed conservatively. His initial normal neurological status worsened on day 6, imaging showed diffuse cerebral edema with meningeal enhancement. His worsening Glasgow coma scale required elective ventilation, and a cerebrospinal fluid tap was done, revealed meningitis, and the culture grew gram-negative coccobacilli (Acinetobacter). He was treated with intrathecal colistin and intravenous meropenem and colistin concurrently. Following clinical improvement, he was extubated after 9 days on the ventilator, and antibiotics de-escalated according to the laboratory values. He was discharged with normal neurological status, and at 6 months follow-up showed no residual deficits. The level of evidence is level 5..