This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (44)  • Contact me when this article is cited  Related Content  • Related article  • Similar articles in this journal  Topic Collections  • Bacterial Infections  • Neurology  • Review  • Alert me on articles by topic  Social Bookmarking   What's this?

German Moris, MD; Juan Carlos Garcia-Monco, MD

Arch Intern Med. 1999;159:1185-1194.

Several drugs can induce the development of aseptic meningitis. Drug-induced aseptic meningitis (DIAM) can mimic an infectious process as well as meningitides that are secondary to systemic disorders for which these drugs are used. Thus, DIAM constitutes a diagnostic and patient management challenge. Cases of DIAM were reviewed through a MEDLINE literature search (up to June 1998) to identify possible clinical and laboratory characteristics that would be helpful in distinguishing DIAM from other forms of meningitis or in identifying a specific drug as the culprit of DIAM. Our review showed that nonsteroidal anti-inflammatory drugs (NSAIDs), antibiotics, intravenous immunoglobulins, and OKT3 antibodies (monoclonal antibodies against the T3 receptor) are the most frequent cause of DIAM. Resolution occurs several days after drug discontinuation and the clinical and cerebrospinal fluid profile (neutrophilic pleocytosis) do not allow DIAM to be distinguished from infectious meningitis. Nor are there any specific characteristics associated with a specific drug. Systemic lupus erythematosus seems to predispose to NSAID-related meningitis. We conclude that a thorough history on prior drug intake must be conducted in every case of meningitis, with special focus on those aforementioned drugs. If there is a suspicion of DIAM, a third-generation cephalosporin seems a reasonable treatment option until cerebrospinal fluid cultures are available.

From the Department of Neurology, Hospital Universitario Marqués de Valdecilla, Santander, Spain (Dr Moris); and the Department of Neurology, Hospital de Galdacano, Vizcaya, Spain (Dr Garcia-Monco).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

RELATED ARTICLE

Archives of Internal Medicine Reader's Choice: Continuing Medical Education
Arch Intern Med. 1999;159(11):1259-1260.
FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Chronic and recurrent meningitis
Ginsberg and Kidd
PN 2008;8:348-361.
ABSTRACT | FULL TEXT  

Aseptic Meningitis Associated With Cephalosporins in an Infant With Trisomy 21
Nakajima et al.
J Child Neurol 2007;22:780-782.
ABSTRACT  

Intravenous immunoglobulins contain naturally occurring antibodies that mimic antineutrophil cytoplasmic antibodies and activate neutrophils in a TNF{alpha}-dependent and Fc-receptor-independent way
Jarius et al.
Blood 2007;109:4376-4382.
ABSTRACT | FULL TEXT  

IgE-Mediated Hypersensitivity After Ibuprofen Administration
Bluth et al.
Annals of Clinical & Laboratory Science 2007;37:362-365.
ABSTRACT | FULL TEXT  

Recurrent ibuprofen-induced aseptic meningitis: Evidence against an antigen-specific immune response
Periard et al.
Neurology 2006;67:539-540.
FULL TEXT  

Possible Trimethoprim/Sulfamethoxazole-Induced Aseptic Meningitis
Therrien
The Annals of Pharmacotherapy 2004;38:1863-1867.
ABSTRACT | FULL TEXT  

Recurrent Ibuprofen-Induced Aseptic Meningitis
Nguyen and Juurlink
The Annals of Pharmacotherapy 2004;38:408-410.
ABSTRACT | FULL TEXT  

Possible Valacyclovir-Related Neurotoxicity and Aseptic Meningitis
Olin and Gugliotta
The Annals of Pharmacotherapy 2003;37:1814-1817.
ABSTRACT | FULL TEXT  

No evidence of type 1 or type 3 hypersensitivity mechanism in amoxicillin/clavulanic acid induced aseptic meningitis
Kastenbauer et al.
J. Neurol. Neurosurg. Psychiatry 2003;74:690-691.
FULL TEXT  

Recurrent aseptic meningitis due to different non-steroidal anti-inflammatory drugs including rofecoxib
Ashwath and Katner
Postgrad. Med. J. 2003;79:295-296.
ABSTRACT | FULL TEXT  

Pentoxifylline-induced aseptic meningitis in a patient with mixed connective tissue disease
Mathian et al.
Neurology 2002;59:1468-1469.
FULL TEXT  

Trimethoprim-Induced Aseptic Meningitis in an Adolescent Male
Redman et al.
Pediatrics 2002;110:e26-26.
ABSTRACT | FULL TEXT  

Aseptic meningo-encephalitis related to dexibuprofen use in a patient with systemic lupus erythematosus: a case report with MR findings
Obermoser et al.
Lupus 2002;11:451-453.
ABSTRACT  

Amoxicillin-induced aseptic meningitis
Wittmann and Wooten
Neurology 2001;57:1734-1734.
FULL TEXT  

Interleukin 6 May Be an Important Mediator of Trimethoprim-Induced Systemic Adverse Reaction Resembling Aseptic Meningitis
Antonen et al.
Arch Intern Med 2000;160:2066-2067.
FULL TEXT  

Still's disease can cause neutrophilic meningitis
Blockmans et al.
Neurology 2000;54:1203-1205.
FULL TEXT  

Amoxicillin Can Induce Aseptic Meningitis
Czerwenka et al.
Arch Intern Med 1999;159:2746-2746.
FULL TEXT  

Drug-Induced Benign Meningitis: A Diagnostic Challenge
JWatch Neurology 1999;1999:14-14.
FULL TEXT