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Published on: May 7, 2020
Intramuscular methotrexate-induced aseptic meningitis.
1School of Pharmacy, Health Sciences Centre, Department of Pharmacy, Eastern Health, St. John's, Newfoundland, Canada. hawboldt@mun.ca
The Annals of Pharmacotherapy
|September 20, 2007
Summary
This case study reports the first instance of aseptic meningitis in a rheumatoid arthritis patient receiving intramuscular methotrexate. The condition recurred upon drug rechallenge, confirming a probable link.
Area of Science:
- Neurology
- Rheumatology
- Clinical Pharmacology
Background:
- Methotrexate is a common disease-modifying antirheumatic drug (DMARD).
- Aseptic meningitis is a rare but serious adverse effect associated with methotrexate, typically reported with intrathecal administration.
Observation:
- A 62-year-old male with rheumatoid arthritis developed recurrent aseptic meningitis.
- Symptoms included headache, neck stiffness, and fever, with cerebrospinal fluid findings consistent with meningitis.
- The patient experienced three episodes of aseptic meningitis, two requiring hospitalization, following intramuscular methotrexate administration, particularly after dose escalation.
Findings:
- This case represents the first documented instance of aseptic meningitis induced by intramuscular methotrexate.
- The Naranjo probability scale indicated a probable relationship between methotrexate use and the development of aseptic meningitis.
- Recurrence of symptoms upon drug rechallenge strongly supports the causal link.
Implications:
- Clinicians should consider aseptic meningitis in patients with rheumatoid arthritis on intramuscular methotrexate presenting with suggestive symptoms.
- This finding expands the known adverse effect profile of methotrexate, highlighting potential risks with non-intrathecal routes.
- Further investigation into the mechanisms of methotrexate-induced aseptic meningitis, even with intramuscular administration, is warranted.
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