Proteus mirabilis meningitis following lumbar spine surgery in an elderly diabetic patient: a rare case report

Abstract

Postoperative meningitis is a rare complication following spine surgeries, more commonly caused by gram-positive organisms. Proteus mirabilis, a gram-negative bacillus, is a highly unusual causative agent, particularly in adults and post-spinal surgery cases. Elderly patients with comorbidities, especially diabetes mellitus, are at elevated risk for serious postoperative infections, with prognosis dependent on early diagnosis and aggressive management. A 76-year-old female with diabetes mellitus underwent transforaminal lumbar interbody spinal fusion (TLIF) for L4-L5 spondylolisthesis. She presented with altered sensorium, vomiting and generalised seizures ten days post-discharge. CSF analysis confirmed neutrophilic pleocytosis and culture yielded Proteus mirabilis which is extremely rare occurrence. Management with intravenous antibiotics and supportive care led to complete neurological recovery. Extensive literature review confirms the rarity of such cases and highlights the formidable mortality associated with gram-negative postoperative CNS infections. This case underscores the necessity of high vigilance for atypical pathogens in elderly, immunocompromised patients presenting with CNS symptoms post-surgery and the critical importance of timely, targeted therapy for optimal outcomes.