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Nosocomial aseptic meningitis associated with administration of OKT3

M A Martin1, R M Massanari, D D Nghiem

  • 1Department of Medicine, University of Iowa College of Medicine, Iowa City.

JAMA
|April 1, 1988
PubMed

Insights

Aseptic meningitis occurred in renal transplant patients treated with the murine monoclonal antibody OKT3 (muromonab-CD3) for acute allograft rejection. This condition was strongly associated with OKT3 administration and appeared to be self-limiting.

Area of Science:

  • Nephrology
  • Immunology
  • Infectious Diseases

Background:

  • Nosocomial aseptic meningitis is a rare complication in immunocompromised patients.
  • The murine monoclonal antibody OKT3 (muromonab-CD3) is used to treat acute renal allograft rejection.
  • An outbreak of meningitis was observed in renal transplant recipients.

Purpose of the Study:

  • To investigate an outbreak of aseptic meningitis in renal allograft recipients.
  • To identify potential risk factors for meningitis in transplant patients.
  • To determine the association between OKT3 therapy and aseptic meningitis.

Main Methods:

  • Retrospective case-control study comparing patients with and without meningitis.
  • Cerebrospinal fluid cultures were performed to rule out infectious causes.
  • Prospective surveillance of meningitis in patients receiving OKT3 was implemented.

Main Results:

  • Four renal allograft recipients developed aseptic meningitis within 72 hours of OKT3 administration.
  • No infectious agents were isolated from cerebrospinal fluid.
  • Aseptic meningitis was strongly associated with OKT3 treatment.
  • Prospective surveillance identified 3 cases (14%) of aseptic meningitis in 21 patients treated with OKT3.

Conclusions:

  • Administration of OKT3 is strongly associated with the development of aseptic meningitis in renal transplant recipients.
  • The clinical course of OKT3-associated aseptic meningitis appears benign and self-limited.
  • Continued surveillance of OKT3 therapy for meningitis is warranted.

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