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Naproxen-induced recurrent aseptic meningitis
1Department of Medicine, Cornell University Medical College, New York, NY 10021.
Abstract:
Aseptic meningitis has been linked to treatment with several nonsteroidal antiinflammatory drugs (e.g., ibuprofen, tolmetin, sulindac), particularly in patients with disturbed immunity. Naproxen, however, has only once been reported to cause meningitis. We report a case of recurrent aseptic meningitis related to prolonged naproxen usage in a 38-year-old woman with longstanding, minimally symptomatic systemic lupus erythematosus (SLE). Two years after starting naproxen, she experienced three separate episodes of meningitis within a period of 10 months; each episode was preceded by resumption of naproxen administration or an increase in drug dosage. There was no clinical or serologic evidence for the flare-ups of her SLE. Discontinuation of naproxen was followed by prompt recovery once the relationship of the drug to her symptoms was realized. Off the drug, the patient has remained free of meningeal symptoms for more than 18 months. Nonsteroidal antiinflammatory agents should be considered as possible causal agents in evaluating meningitis of obscure etiology.
Insights
Recurrent aseptic meningitis was linked to naproxen use in a patient with systemic lupus erythematosus (SLE). Stopping naproxen resolved the meningitis, highlighting NSAIDs as potential causes for unexplained meningitis.
Area of Science:
- Neurology
- Rheumatology
- Pharmacology
Background:
- Aseptic meningitis is associated with nonsteroidal anti-inflammatory drugs (NSAIDs), especially in immunocompromised individuals.
- Naproxen has rarely been implicated in causing meningitis.
Observation:
- A 38-year-old woman with systemic lupus erythematosus (SLE) developed recurrent aseptic meningitis.
- Episodes correlated with naproxen initiation or dosage increases, with no signs of SLE flare.
Findings:
- Discontinuation of naproxen led to rapid symptom resolution.
- The patient remained meningitis-free for over 18 months after stopping naproxen.
Implications:
- Naproxen can cause recurrent aseptic meningitis, particularly in patients with underlying autoimmune conditions like SLE.
- NSAIDs should be considered in the differential diagnosis of meningitis with unknown causes.