As part of a multi-state investigation, the Maryland Department of Health and Mental Hygiene is studying the connection between an epidural steroid and meningitis; and two cases have been identified in the state.

One of the affected individuals died and no further information about the cases is being provided, according to a news release. Maryland facilities that carried the steroid have been contacted to ensure removal and notification of patients who may have been exposed from July 30 to Sept. 28.

According to the department, symptoms of meningitis include nausea, fever, headache, photophobia and vomiting.

The situation first came to light when a group of patients at a Tennessee ambulatory care clinic acquired meningitis and stroke symptoms within a month of receiving the epidural steroid spinal injection, the release reads. Aspergillus meningitis was found in one patient, but no organisms were found in the others. North Carolina is also looking into possible connection.

The manufacturer of Solumedrol, which was used on all affected patients, has voluntarily recalled the product, although the cause of the illnesses are not know, according to the release.

The following Maryland facilities have carried and since removed the epidural steroid:

Berlin Interventional Pain Management, Berlin, MD

Box Hill Surgery Center, Abingdon, MD

Greenspring Surgery Center, Baltimore, MD

Harford County Ambulatory Surgery Center, Edgewood, MD

Maryland Pain Specialists, Towson, MD

SurgCenter of Bel Air, Bel Air, MD

Zion Ambulatory Center, Baltimore, MD