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Suspected allopurinol-induced aseptic meningitis
L E Greenberg1, T Nguyen, S M Miller
1Department of Pharmacy Services, Ben Taub General Hospital, Houston, Texas 77030, USA.
Pharmacotherapy
|November 23, 2001
Summary
Drug-induced aseptic meningitis can mimic infectious meningitis. This case highlights allopurinol as a potential cause, emphasizing the need to consider drug reactions when other causes are ruled out.
Area of Science:
- Neurology
- Pharmacology
- Internal Medicine
Background:
- Drug-induced aseptic meningitis presents with symptoms mimicking infectious meningitis, posing diagnostic challenges.
- A 60-year-old male with a history of renal stones developed fever, chills, and altered mental status.
- The patient had recently taken levofloxacin, allopurinol, and acetazolamide.
Observation:
- No infectious etiology was identified despite thorough investigation.
- Upon resuming allopurinol at home, the patient rapidly experienced a recurrence of symptoms, necessitating rehospitalization.
- These recurrent symptoms strongly suggested an adverse drug reaction.
Findings:
- The patient was diagnosed with suspected drug-induced aseptic meningitis.
- The adverse drug reaction was strongly attributed to allopurinol.
- Cerebrospinal fluid analysis did not reveal infectious etiologies or pleocytosis.
Implications:
- Clinicians should consider drug-induced aseptic meningitis in patients presenting with meningitis-like symptoms when infectious causes are excluded.
- Prompt recognition and withdrawal of the suspected causative agent, such as allopurinol, are crucial for patient recovery.
- This case underscores the importance of a comprehensive medication history in diagnosing complex neurological presentations.