[Rifampin-induced severe aseptic meningitis]

Area of Science:

• Rheumatology
• Neurology
• Infectious Diseases

Background:

• Drug-induced aseptic meningitis (DIAM) is an uncommon adverse drug reaction.
• Patients with autoimmune diseases, especially systemic lupus erythematosus (SLE), are more susceptible to DIAM.
• Commonly implicated drug classes include NSAIDs, antimicrobials, IVIg, and biotherapies.

Observation:

• A young female patient with a history of SLE presented with symptoms suggestive of meningitis.
• Diagnostic workup revealed findings consistent with aseptic meningitis.
• Causative agent identification led to rifampin as the trigger.

Findings:

• This report details the first documented case of acute DIAM specifically attributed to rifampin.
• The patient's SLE likely contributed to her heightened susceptibility to this drug hypersensitivity reaction.
• The diagnosis of DIAM was challenging due to its rarity and overlapping symptoms with other conditions.

Implications:

• Clinicians should consider DIAM in SLE patients presenting with meningitis, even with unusual triggers like rifampin.
• Early recognition and discontinuation of the offending drug are crucial for managing DIAM.
• This case expands the known spectrum of drugs causing DIAM and underscores the importance of thorough drug history in autoimmune patients.