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The challenge of drug-induced aseptic meningitis
1Department of Neurology, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
Abstract:
Several drugs can induce the development of aseptic meningitis. Drug-induced aseptic meningitis (DIAM) can mimic an infectious process as well as meningitides that are secondary to systemic disorders for which these drugs are used. Thus, DIAM constitutes a diagnostic and patient management challenge. Cases of DIAM were reviewed through a MEDLINE literature search (up to June 1998) to identify possible clinical and laboratory characteristics that would be helpful in distinguishing DIAM from other forms of meningitis or in identifying a specific drug as the culprit of DIAM. Our review showed that nonsteroidal anti-inflammatory drugs (NSAIDs), antibiotics, intravenous immunoglobulins, and OKT3 antibodies (monoclonal antibodies against the T3 receptor) are the most frequent cause of DIAM. Resolution occurs several days after drug discontinuation and the clinical and cerebrospinal fluid profile (neutrophilic pleocytosis) do not allow DIAM to be distinguished from infectious meningitis. Nor are there any specific characteristics associated with a specific drug. Systemic lupus erythematosus seems to predispose to NSAID-related meningitis. We conclude that a thorough history on prior drug intake must be conducted in every case of meningitis, with special focus on those aforementioned drugs. If there is a suspicion of DIAM, a third-generation cephalosporin seems a reasonable treatment option until cerebrospinal fluid cultures are available.
Insights
Drug-induced aseptic meningitis (DIAM) is a diagnostic challenge, often mimicking infections. Identifying culprit drugs like NSAIDs requires a thorough patient history, as clinical signs are non-specific.
Area of Science:
- Neurology
- Pharmacology
- Infectious Diseases
Background:
- Drug-induced aseptic meningitis (DIAM) presents a diagnostic challenge, mimicking infectious meningitis and systemic disorders.
- Accurate diagnosis is crucial for appropriate patient management and preventing complications.
Purpose of the Study:
- To review cases of DIAM to identify clinical and laboratory characteristics.
- To aid in distinguishing DIAM from other meningitis forms and identifying causative agents.
Main Methods:
- MEDLINE literature search up to June 1998.
- Review of clinical and laboratory data from DIAM cases.
Main Results:
- Nonsteroidal anti-inflammatory drugs (NSAIDs), antibiotics, intravenous immunoglobulins, and OKT3 antibodies are frequent causes of DIAM.
- Clinical presentation and cerebrospinal fluid analysis (neutrophilic pleocytosis) do not reliably differentiate DIAM from infectious meningitis.
- No specific characteristics link DIAM to a particular drug; systemic lupus erythematosus may increase risk for NSAID-related meningitis.
Conclusions:
- A detailed drug history is essential in all meningitis cases, focusing on common culprits.
- In suspected DIAM cases, initiating a third-generation cephalosporin is a reasonable empirical treatment pending cerebrospinal fluid culture results.