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Elderly Woman With No Autoimmune Disease With Aseptic Meningitis Caused by Celecoxib
Masaki Takigawa1, Hiroyuki Tanaka2, Takashi Kobayashi3
1Department of Clinical Pharmaceutics, Faculty of Pharmaceutical Sciences, Toho University, Chiba, JPN.
Abstract:
Nonsteroidal anti-inflammatory drug (NSAID)-induced aseptic meningitis (NIAM) is frequently reported in patients with autoimmune disease. Ibuprofen-induced NIAM is the most common case report of NIAM. We report a patient without autoimmune disease who developed NIAM following oral celecoxib administration. A literature review and survey of cases registered in the Japanese Adverse Drug Event Report (JADER) database is also provided. A 73-year-old woman with no autoimmune disease developed a headache the day after taking celecoxib, and NIAM was suspected. The headache resolved quickly following celecoxib discontinuation. Although lumbar puncture was not available in this case, bacterial or viral meningitis was negative, and NIAM could not be ruled out. This case involved an older adult patient without an autoimmune disease, with celecoxib as the causative NSAID. A literature review found numerous cases of autoimmune diseases in younger patients. To date, only one case of celecoxib-induced NIAM has been reported. Analysis of NIAM cases in JADER revealed an onset time of approximately three days. JADER analysis indicated that NIAM tended to occur immediately after administration, although the onset with cyclooxygenase-2 selective agents might be slower.
Insights
Nonsteroidal anti-inflammatory drug (NSAID)-induced aseptic meningitis (NIAM) can occur without autoimmune disease. This case highlights celecoxib as a potential NSAID trigger for NIAM in older adults.
Area of Science:
- Neurology
- Pharmacology
- Immunology
Background:
- Nonsteroidal anti-inflammatory drug (NSAID)-induced aseptic meningitis (NIAM) is a known adverse effect, frequently associated with autoimmune diseases.
- Ibuprofen is the most commonly reported NSAID implicated in NIAM cases.
Observation:
- A case of NIAM following oral celecoxib administration in a 73-year-old patient without any autoimmune disease is presented.
- The patient developed a headache shortly after taking celecoxib, which resolved upon discontinuation.
- While lumbar puncture was not performed, infectious meningitis was ruled out, leaving NIAM as a strong possibility.
Findings:
- This report details a rare instance of celecoxib-induced NIAM in an elderly patient lacking autoimmune disease.
- A literature review revealed a predominance of NIAM cases in younger patients with autoimmune conditions.
- Analysis of the Japanese Adverse Drug Event Report (JADER) database indicated an average NIAM onset of approximately three days, with potential for delayed onset with COX-2 selective agents.
Implications:
- This case expands the known clinical spectrum of NIAM, suggesting it can occur in non-autoimmune elderly individuals.
- The findings underscore the importance of considering NIAM in the differential diagnosis of meningitis, even in the absence of typical risk factors.
- Further investigation into the specific mechanisms and risk factors for NIAM with selective COX-2 inhibitors like celecoxib is warranted.
