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A Case of Trimethoprim-Sulfamethoxazole Associated Aseptic Meningitis
Malik W Z Khan1, Abdul Moeez2, Sameen Farooq3
1Yale University School of Medicine New Haven Connecticut USA.
Abstract:
Most cases of aseptic meningitis, or nonsuppurative meningitis, are caused by viruses or systemic diseases. Nonetheless, drug-induced aseptic meningitis should be considered in the differential diagnosis, particularly with the recent use of antibiotics and nonsteroidal anti-inflammatory drugs. We describe a case of meningitis associated with the use of Trimethoprim-Sulfamethoxazole (TMP-SMX) in a 72-year-old male with comorbidities. A 72-year-old male with a history of diabetes, hypertension, Parkinson's disease, benign prostatic hyperplasia, and a recent use of TMP-SMX for a urinary tract infection (UTI) presented with altered mental status, neck rigidity, tachycardia, and a fever of 102.8°F. CT scan of the head and abdomen and chest x-ray revealed no significant findings. Empiric treatment with ampicillin, vancomycin, acyclovir, and ceftriaxone was initiated after two failed attempts at lumbar puncture, resulting in the improvement of all symptoms except for altered mental status within 24 h. Analysis of CSF, obtained via a successful subsequent lumbar puncture, was negative for microorganisms. The patient was labeled as a case of TMP-SMX-induced aseptic meningitis (TSIAM) due to the recent use of the drug for UTI. All the antibiotics and antivirals were discontinued, and all his symptoms resolved within 5 days of presentation. TSIAM is a diagnosis of exclusion, and a low threshold of suspicion should be maintained when CSF microscopy and culture show no microorganisms. This case illustrates the significance of prompt recognition of TSIAM and highlights the importance of thorough history-taking in preventing complications associated with drug-induced aseptic meningitis, thereby improving patient outcomes.
Insights
Drug-induced aseptic meningitis can mimic infections. Trimethoprim-Sulfamethoxazole (TMP-SMX) can cause this condition, emphasizing the need for careful patient history and diagnosis of exclusion.
Area of Science:
- Neurology
- Infectious Diseases
- Pharmacology
Background:
- Aseptic meningitis is typically caused by viruses or systemic diseases.
- Drug-induced aseptic meningitis is an important differential diagnosis, especially after recent antibiotic or NSAID use.
Purpose of the Study:
- To report a case of aseptic meningitis associated with Trimethoprim-Sulfamethoxazole (TMP-SMX).
- To highlight the importance of considering drug-induced causes in aseptic meningitis and the role of thorough patient history.
Main Methods:
- Case report of a 72-year-old male with comorbidities presenting with symptoms of meningitis.
- Diagnostic workup included CT scans, chest x-ray, and cerebrospinal fluid (CSF) analysis.
- Empirical treatment was initiated, followed by discontinuation of TMP-SMX upon diagnosis.
Main Results:
- The patient presented with fever, neck rigidity, and altered mental status after recent TMP-SMX use for a UTI.
- CSF analysis was negative for microorganisms, leading to a diagnosis of TMP-SMX-induced aseptic meningitis (TSIAM).
- Symptom resolution occurred within 5 days after discontinuing TMP-SMX and other empirical treatments.
Conclusions:
- TSIAM is a diagnosis of exclusion that requires a high index of suspicion when CSF is sterile.
- Prompt recognition and discontinuation of the offending drug are crucial for favorable patient outcomes.
- Thorough patient history is vital for identifying drug-induced meningitis and preventing complications.
