Post-Lumbar Puncture Headache Management in Patient with Drug Allergy
Case at a Glance
A 19-year-old female presenting with persistent post-lumbar puncture headache 16 days after diagnostic spinal tap, complicated by concurrent amoxicillin-induced rash requiring antihistamine treatment.
Patient's Story
The patient initially presented with fever of unknown origin requiring diagnostic workup including lumbar puncture to rule out central nervous system infection. Following completion of antibiotic treatment with amoxicillin-clavulanate, the fever resolved but the patient developed a characteristic drug rash. She was subsequently started on cetirizine and famotidine for rash management. Despite resolution of the initial infectious symptoms, the patient continued to experience debilitating positional headaches consistent with cerebrospinal fluid leak.
Initial Assessment
Patient presents with classic post-dural puncture headache symptoms persisting 16 days post-procedure. Physical examination reveals healing lumbar puncture site with no signs of infection. Drug rash is present but stable on current antihistamine regimen. Neurological examination is otherwise unremarkable with no focal deficits.
The Diagnostic Journey
Initial lumbar puncture performed for fever workup yielded negative results for bacterial meningitis and other CNS infections. The prolonged duration of post-procedural headache (16 days) raises questions about the typical timeline for spontaneous resolution versus need for interventional management. Consideration given to potential underlying factors contributing to persistent CSF leak.
Final Diagnosis
Post-dural puncture headache secondary to cerebrospinal fluid leak following diagnostic lumbar puncture, with concurrent amoxicillin-induced drug rash.
Treatment Plan
Evaluation for epidural blood patch procedure while managing concurrent drug allergy. Conservative measures including bed rest, increased fluid intake, and caffeine supplementation to be continued. Anesthesiology consultation recommended for blood patch consideration, with careful evaluation of contraindications related to current antihistamine therapy. Trial of intravenous medications for headache relief may be attempted prior to invasive intervention.
Outcome and Follow-up
Patient requires urgent evaluation given prolonged symptom duration. Blood patch procedure feasibility to be determined by anesthesiology team, taking into account current medication regimen for rash management. Close monitoring for headache resolution and any complications from delayed intervention needed.