Simultaneous pneumocephalus and meningitis as a complication of ozone therapy
Elmas Dal S. Northern Clinics of Istanbul, 2026.
- Study type
- Case report
- People studied
- 1 person
- Population
- 38-year-old man with ankylosing spondylitis, given ozone injections at a private clinic into the paravertebral back and lumbar regions and the front of the neck for pain
- Published
- 2026, Northern Clinics of Istanbul
- Identifiers
- PMID 42516792, DOI 10.14744/nci.2026.97830
What the authors reported
A day after paravertebral ozone injections along the back and lumbar area and into the front of the neck at a private clinic, the patient had headache, fever, vomiting, confusion, and neck stiffness. CT showed air in the left lateral ventricle; cerebrospinal fluid held 4000 leukocytes/mm3, with negative cultures. On empirical antibiotics and dexamethasone the air was gone by day 14; he recovered.
What limits this result
Single case report. Cerebrospinal fluid was sampled after antibiotics had begun, and no organism was identified. The author considers a contaminated needle that entered the subarachnoid space the likely cause; no ozone dose, volume, or needle depth is reported, and follow-up ended one week after discharge.
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How the study was done
- Design
- Case report (single author)
Our study presents a case of pneumocephaly and meningitis due to the injection of an intramuscular O2-O3 mixture directed into the subarachnoid space after dural puncture for the treatment of low back pain.
- Setting
- Department of Infectious Diseases, Malatya Turgut Ozal University, Malatya, Turkiye (author affiliation); the ozone was given at a private clinic
- Read from
- Read from the full text of the paper. Read on October 2, 2026.
Source: Abstract on PubMed
Study arms
| Group | Participants | What they received |
|---|---|---|
| Single patient | Not reported | Ozone therapy at a private clinic two days before admission, given to the right and left paravertebral regions of the back and lumbar area and the front of the neck |
Source: Full text on PubMed Central
What it measured
- Onset
- One day after the procedure: severe headache, fever, chills, dizziness, and vomiting
One day following this procedure, which targeted the entire spine and neck area, he presented to the emergency department with symptoms of severe headache, fever, chills, dizziness, and vomiting.
- Examination in the emergency department
- Confusion, neck stiffness, blood pressure 160/70 mmHg, temperature 37.8°C
- Brain CT
- Air-density lesions in the temporal and frontal horns of the left lateral ventricle (pneumocephalus)
- Cerebrospinal fluid
- Slightly cloudy; leukocytes 4000/mm3, protein 483 mg/dL, glucose 40 mg/dL, chlorine 113 mmol/L
- Microbiology
- No organisms on acid-fast or Gram staining; no growth in CSF tuberculosis, blood, or CSF cultures
- Treatment
- Empirical intravenous meropenem, vancomycin, and dexamethasone, started before the lumbar puncture
was empirically started on intravenous meropenem (3×2 g), vancomycin (4×500 mg), and dexamethasone (4×8 mg) pending cerebrospinal fluid (CSF) culture results
- Brain imaging on day 14 of treatment
- CT normal, indicating resolution of the pneumocephalus; subsequent MRI also normal
A follow-up CT scan of the brain on the 14 th day of treatment revealed a normal appearance, indicating resolution of the pneumocephalus, and subsequent magnetic resonance imaging was also normal.
- Repeat lumbar puncture on day 14
- No cells in the cerebrospinal fluid
Safety as reported
Pneumocephalus and meningitis after ozone therapy, which the author considers likely due to a contaminated needle that advanced from the epidural space into the subarachnoid spaceHere, we present a case of pneumocephalus and meningitis following O 3 therapy for low back pain, likely due to a contaminated needle that inadvertently advanced from the epidural space into the subarachnoid space.
Source: Full text on PubMed Central
Follow-up
Outpatient review one week after discharge: normal examination, no complaintsUpon follow-up in the outpatient clinic 1 week later, his examination was normal, and he reported no complaints.
Source: Full text on PubMed Central
Funding and conflicts
No financial support received
Source: Full text on PubMed Central
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