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Drug-Induced Aseptic Meningitis: A 25-Year Systematic Review of Case Reports
Madhusudan Prasad Singh1, Riya Yadav1, Juhi Singh2
1Department of Pharmacology, All India Institute of Medical Sciences, Raipur, Chhattisgarh.
Objectives:
This systematic review characterizes drug-induced aseptic meningitis (DIAM), a rare but clinically significant adverse drug reaction. The study synthesizes data from published case reports and case series to enhance diagnostic accuracy and guide management strategies.
Methods:
A comprehensive literature search was conducted in PubMed/MEDLINE, Scopus, Embase, Cochrane Library, ClinicalTrials.gov, and gray literature following PRISMA guidelines. Cases with detailed clinical and therapeutic data were included.
Results:
A total of 98 reports involving 108 patients were analyzed. The mean patient age was 47 years, with a slight female predominance (55%). The most commonly implicated drugs were nonsteroidal anti-inflammatory drugs, antibiotics, and monoclonal antibodies. Symptoms typically included headache (78%), fever (65%), and neck stiffness (56%), with severe neurological manifestations in 17%. Cerebrospinal fluid analysis showed pleocytosis in 65% and elevated protein in 60%. Magnetic resonance imaging findings were variable. Drug discontinuation led to symptom resolution in all cases, with corticosteroids used in severe presentations.
Conclusions:
DIAM mimics infectious meningitis, making early recognition critical. A thorough patient history, including medication exposure, is essential for diagnosis. This review underscores the need for clinician awareness to facilitate prompt identification and management. Future research should explore the immunopathogenesis and evidence-based treatment strategies for DIAM.
Insights
Drug-induced aseptic meningitis (DIAM) mimics infections, requiring careful diagnosis. Prompt recognition and medication review are key for effective management of this rare adverse drug reaction.
Area of Science:
- Neurology
- Pharmacology
- Infectious Diseases
Background:
- Drug-induced aseptic meningitis (DIAM) is a rare but significant adverse drug reaction.
- DIAM often mimics infectious meningitis, complicating diagnosis and management.
- Systematic reviews are needed to characterize DIAM and improve clinical practice.
Purpose of the Study:
- To systematically review and characterize drug-induced aseptic meningitis (DIAM).
- To synthesize data from published case reports and series to enhance diagnostic accuracy.
- To guide management strategies for drug-induced aseptic meningitis.
Main Methods:
- Comprehensive literature search across multiple databases (PubMed/MEDLINE, Scopus, Embase, Cochrane Library, ClinicalTrials.gov) and gray literature.
- Adherence to PRISMA guidelines for systematic reviews.
- Inclusion of cases with detailed clinical and therapeutic data.
Main Results:
- Analysis of 98 reports involving 108 patients; mean age 47 years, 55% female.
- Commonly implicated drugs include NSAIDs, antibiotics, and monoclonal antibodies.
- Typical symptoms: headache (78%), fever (65%), neck stiffness (56%); 17% had severe neurological issues. CSF showed pleocytosis (65%) and elevated protein (60%).
Conclusions:
- DIAM diagnosis requires high clinical suspicion and thorough medication history due to its mimicry of infectious meningitis.
- Prompt identification and discontinuation of the offending drug are crucial for resolution.
- Further research into immunopathogenesis and evidence-based treatments for DIAM is warranted.
