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Drug-induced aseptic meningitis: diagnosis and management
S Jolles1, W A Sewell, C Leighton
1Division of Cellular Immunology, National Institute for Medical Research, London, England. sjolles@nimr.mrc.ac.uk
Abstract:
Drug-induced aseptic meningitis (DIAM) has been reported as an uncommon adverse reaction with numerous agents. It is a diagnosis of exclusion, and clinical signs and CSF findings vary greatly. The body of evidence regarding DIAM is largely in the form of anecdotal case reports and must be interpreted carefully bearing this in mind. The major categories of causative agents are nonsteroidal anti-inflammatory drugs, antimicrobials, intravenous immunoglobulin, intrathecal agents, vaccines and a number of other less frequently reported agents. There appears to be an association between DIAM and connective tissue disease, particularly systemic lupus erythematosus, and ibuprofen. There are 2 major proposed mechanisms for DIAM. The first involves direct irritation of the meninges by intrathecal administration of the drug, and the second involves immunological hypersensitivity to the drug, most likely type III and type IV hypersensitivity. Recognition and diagnosis of DIAM is important, as it is treatable by withdrawal of the drug and recurrence is prevented. The outcome of DIAM is generally good, usually without long term sequelae. This article describes the case reports of DIAM in the current literature and discusses the diagnosis and management of this rare complication.
Insights
Drug-induced aseptic meningitis (DIAM) is a rare adverse reaction to various medications. Early diagnosis and drug withdrawal are key to successful treatment and recovery, with generally good outcomes.
Area of Science:
- Neurology
- Pharmacology
- Immunology
Background:
- Drug-induced aseptic meningitis (DIAM) is an uncommon adverse reaction associated with diverse agents.
- Diagnosis relies on excluding other causes, with variable clinical signs and cerebrospinal fluid (CSF) findings.
- Existing evidence is primarily from case reports, requiring careful interpretation.
Purpose of the Study:
- To review case reports of DIAM in the current literature.
- To discuss the diagnosis and management of this rare complication.
Main Methods:
- Literature review of case reports on DIAM.
- Analysis of causative agents, proposed mechanisms, and clinical presentations.
Main Results:
- Common causative agents include NSAIDs, antimicrobials, IVIG, intrathecal agents, and vaccines.
- Association noted between DIAM, connective tissue disease (e.g., SLE), and ibuprofen.
- Proposed mechanisms include direct meningeal irritation and Type III/IV hypersensitivity reactions.
Conclusions:
- DIAM is a treatable condition; drug withdrawal is crucial for management and prevention of recurrence.
- Prompt recognition and diagnosis are important for favorable outcomes, typically without long-term sequelae.