[Trimethoprim-sulphamethoxazole-induced meningitis]

Area of Science:

• Neurology
• Pharmacology
• Infectious Diseases

Background:

• Aseptic meningitis is often recurrent and challenging to diagnose.
• Drug-induced meningitis is infrequently considered in the differential diagnosis.
• Trimethoprim-sulphamethoxazole is a common antibiotic with potential adverse effects.

Observation:

• A 74-year-old male presented with recurrent aseptic meningitis.
• Symptoms mimicked bacterial meningitis, except for normal cerebrospinal fluid glucose.
• Recurrence was linked to re-exposure to trimethoprim-sulphamethoxazole (Resprim).

Findings:

• Extensive investigations including microbiological, serologic, and imaging studies were negative.
• Cessation of trimethoprim-sulphamethoxazole resulted in rapid and complete resolution of symptoms.
• Follow-up lumbar puncture confirmed normalization of cerebrospinal fluid parameters.

Implications:

• Drug-induced meningitis should be considered in cases of recurrent aseptic meningitis.
• Identifying and withdrawing the causative drug is crucial for patient recovery.
• This case underscores the importance of a thorough drug history in meningitis workups.