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Trimethoprim-induced aseptic meningitis in a patient with AIDS: case report and review

M S Harrison1, S J Simonte, C A Kauffman

  • 1Department of Internal Medicine, University of Michigan Medical School, Ann Arbor.

Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America
|September 1, 1994
PubMed

Insights

Aseptic meningitis can be recurrently triggered by trimethoprim-sulfamethoxazole (TMP-SMZ) or trimethoprim (TMP) alone. Consider this drug-induced meningitis in patients with recurrent symptoms, especially those with collagen-vascular diseases.

Area of Science:

  • Neurology
  • Infectious Diseases
  • Pharmacology

Background:

  • Trimethoprim-sulfamethoxazole (TMP-SMZ) and trimethoprim (TMP) are commonly prescribed antibiotics.
  • Aseptic meningitis is an inflammation of the membranes surrounding the brain and spinal cord, not caused by bacterial infection.

Observation:

  • A case of a human immunodeficiency virus-infected male experiencing two distinct episodes of aseptic meningitis temporally linked to TMP-SMZ and TMP ingestion.
  • Symptoms included abrupt onset of fever, headache, flushing, somnolence, hearing loss, and aphasia, with cerebrospinal fluid (CSF) showing pleocytosis and elevated protein.
  • Resolution occurred within 48 hours of drug cessation.

Findings:

  • A review of 18 prior cases revealed TMP-SMZ or TMP as the cause of aseptic meningitis, predominantly in women (17/18).
  • These cases shared similar abrupt onset and rapid resolution patterns.
  • Six patients had underlying collagen-vascular diseases, and many experienced recurrent meningitis before diagnosis.

Implications:

  • TMP-SMZ or TMP-induced meningitis should be suspected in patients presenting with recurrent aseptic meningitis.
  • Prompt drug withdrawal is crucial for symptom resolution.
  • Awareness of this adverse drug reaction is important for clinicians managing patients on these antibiotics, particularly those with predisposing conditions.

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