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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.
Abstract:
Drug-induced aseptic meningitis is a syndrome with symptoms similar to those of infectious meningitis. A 60-year-old man with a history of recurrent renal stones was admitted to the hospital with fever, chills, and mental status changes after taking levofloxacin, allopurinol, and acetazolamide. No infectious source was identified. Once home, he resumed allopurinol, and within 2 hours, he experienced the same symptoms, requiring rehospitalization. He was diagnosed with suspected meningitis from an adverse drug reaction that we believe was due to allopurinol. It is important to remember, when all other causes are ruled out, that a patient's symptoms may be a drug-induced adverse effect. Drug-induced aseptic meningitis should be considered when patients with symptoms similar to those of infectious meningitis appear without infectious etiologies or cerebrospinal fluid pleocytosis, a suspected agent was recently started, and resolution of adverse effects occurs when the agent is withdrawn.
Insights
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.