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Trimethoprim-sulfamethoxasole induced meningitis in systemic lupus erythematosus
1Arthritis Service, Rancho Los Amigos Medical Center, Downey, CA.
Abstract:
Most reports of drug induced meningitis in systemic lupus erythematosus (SLE) have implicated ibuprofen. We describe a 46-year-old woman with SLE who developed aseptic meningitis abruptly after ingesting trimethoprim-sulfamethoxasole (TMP-SMX). This patient had received TMP-SMX twice before; each was associated with increasingly severe reactions, whose relationship with the use of TMP-SMX became apparent only in retrospect. A history of medication use should be sought in all patients with meningitis who have an underlying autoimmune disorder.
Insights
Trimethoprim-sulfamethoxazole (TMP-SMX) can cause drug-induced aseptic meningitis in patients with systemic lupus erythematosus (SLE). Retrospective analysis revealed a history of severe reactions to TMP-SMX in a patient who developed meningitis.
Area of Science:
- Clinical Medicine
- Neurology
- Rheumatology
Background:
- Systemic lupus erythematosus (SLE) is an autoimmune disease with diverse clinical manifestations.
- Drug-induced meningitis is a rare but serious adverse reaction to certain medications.
- Ibuprofen is the most commonly reported drug causing meningitis in SLE patients.
Observation:
- A 46-year-old woman with a history of SLE presented with acute aseptic meningitis.
- The patient had ingested trimethoprim-sulfamethoxazole (TMP-SMX) prior to symptom onset.
- Previous exposures to TMP-SMX were associated with escalating, unrecognized adverse reactions.
Findings:
- Trimethoprim-sulfamethoxazole (TMP-SMX) was identified as the causative agent for aseptic meningitis in this SLE patient.
- The patient experienced increasingly severe reactions with prior TMP-SMX use, suggesting a pattern of hypersensitivity.
- Diagnosis was confirmed retrospectively by linking meningitis symptoms to TMP-SMX ingestion.
Implications:
- Clinicians should consider TMP-SMX as a potential cause of aseptic meningitis in SLE patients.
- A detailed medication history is crucial for diagnosing meningitis in patients with autoimmune disorders.
- Increased awareness of TMP-SMX-induced meningitis may improve patient outcomes and prevent future occurrences.