Recurrent ibuprofen-induced aseptic meningitis: Evidence against an antigen-specific immune response

Abstract

Drug-induced aseptic meningitis (DIAM) may be difficult to differentiate from bacterial meningitis or from manifestations of the underlying disease.1,2 We report a patient with recurrent ibuprofen-induced aseptic meningitis, whose history suggests an antigen-specific T-cell mechanism. A 55-year-old man began a treatment of ibuprofen for osteoarthritis of the hip. After 3 months of nonspecific flu-like symptoms and muscle pain, he presented with an acute onset of headache, fever, meningism, and dizziness. CSF analysis disclosed an enhanced cell count (145 cells/mm3, predominantly polymorphonuclear cells and macrophages), enhanced proteinorachia (1,230 mg/L), but a normal glucose level. Blood and CSF cultures, viral serologies, and antinuclear factor were negative. Symptoms improved after ibuprofen was stopped. Subsequently the patient occasionally took aspirin and mefenamic acid without any adverse effect. A follow-up CSF analysis was normal. Nine months later, a single dose of 600 mg ibuprofen was administered, and within 90 minutes, the patient presented with fever, chills, headache, …