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[Aseptic meningitis ornidazole-induced in the course of infectious endocarditis]
M Mondon1, L Ollivier, A Daumont
1Fédération d'endocrinologie, hôpital de l'Antiquaille, 1, rue de l'Antiquaille, 69321 Lyon, France.
Introduction:
Drug-induced aseptic meningitis (DIAM) has been reported as an uncommon adverse reaction to treatment, nonsteroidal anti-inflammatory drugs (NAIDS) stand for most of the published cases. EXEGIS: Our observation reports the first case of a meningeal syndrome with fever, after the administration of ornidazole, with biological aseptic meningitis with lymphocyte prodominance. Spontaneous recovery occurred within a few days and without sequelae. It involved a patient with endocarditis and revealing an intramucous sigmoid adenocarcinoma. The rest of the infection tests was negative.
Conclusion:
We concluded that we were in the presence of a DIAM, with ornidazole as the most probable implicated agent. This diagnosis is suggested in front of a recurring meningeal syndrome without any other apparent etiology, hence the importance of the questioning of the patient. Pending objective evidence usually provided by rechallenge, an antibiotic therapy is necessary, because it is, above all, a diagnosis of exclusion.
Insights
Drug-induced aseptic meningitis (DIAM) is a rare side effect, most commonly linked to NSAIDs. This case highlights ornidazole as a potential cause of DIAM, emphasizing patient history for diagnosis.
Area of Science:
- Neurology
- Pharmacology
- Infectious Diseases
Background:
- Drug-induced aseptic meningitis (DIAM) is an infrequent adverse drug reaction.
- Nonsteroidal anti-inflammatory drugs (NSAIDs) are the most frequently implicated agents in reported DIAM cases.
Observation:
- This report details the first case of meningeal syndrome with fever following ornidazole administration.
- The patient presented with biological aseptic meningitis characterized by lymphocyte predominance.
- The patient had a history of endocarditis and was diagnosed with intramucous sigmoid adenocarcinoma.
Findings:
- Ornidazole was identified as the most probable causative agent for DIAM in this patient.
- The patient experienced spontaneous recovery within days, with no lasting sequelae.
- Infection tests were negative, supporting an aseptic meningitis diagnosis.
Implications:
- This case underscores the importance of considering ornidazole as a potential cause of DIAM.
- A thorough patient history is crucial for diagnosing recurrent meningeal syndromes of unknown etiology.
- DIAM is a diagnosis of exclusion, often requiring antibiotic treatment while awaiting definitive evidence.