Drug-induced Aseptic Meningitis Research Articles

Leflunomide-induced aseptic meningitis

Drug-induced aseptic meningitis is uncommon and occurs primarily in patients with autoimmune disease. We report the first known case of leflunomide-induced aseptic meningitis, in a patient with rheumatoid arthritis.

Drug-induced aseptic meningitis.

Aseptic meningitis is a rare but well-recognized complication of drug therapy. The clinical presentation of drug-induced aseptic meningitis (DIAM) is distinct. Symptoms typically include fever, neck stiffness, headache, confusion, nausea and vomiting. The major categories of causative agents are non-steroidal anti-inflammatory drugs, antimicrobials and also intravenous immunoglobulins, monoclonal antibodies and vaccines. These drugs most commonly implicated as causes of aseptic meningitis act more likely through an immunological mechanisms. However, the exact pathogenetic mechanism of DIAM is still unknown. The diagnosis of drug-induced aseptic meningitis is difficult and infectious etiologies must be excluded. In some cases the diagnosis has been confirmed by rechallenging the patient with the suspected agent. In this case, informed written consent is necessary and rechallenge must be medically supervised both to document the response and to offer medical care and advice, if required. The outcome of DIAM is generally good, usually without long term sequelae.

Méningite aseptique rapportée à l'ornidazole au cours d'une endocardite infectieuse

Introduction. – Drug-induced aseptic meningitis (DIAM) has been reported as an uncommon adverse reaction to treatment, nonsteroidal anti-inflamatory drugs (NAIDS) stand for most of the published cases. Exegis. – Our observation reports the first case of a meningeal syndrome with fever, after the administration of ornidazole, with biological aseptic meningitis with lymphocyte prodominance. Spontaneous recovery occurred within a few days and without sequelae. It involved a patient with endocarditis and revealing an intramucous sigmoïd adenocarcinoma. The rest of the infection tests was negative. Conclusion. – We concluded that we were in the presence of a DIAM, with ornidazole as the most probable implicated agent. This diagnosis is suggested in front of a recurring meningeal syndrome without any other apparent etiology, hence the importance of the questioning of the patient. Pending objective evidence usually provided by rechallenge, an antibiotic therapy is necessary, because it is, above all, a diagnosis of exclusion.

Drug-induced aseptic meningitis: diagnosis and management.

Drug-induced aseptic meningitis (DIAM) has been reported as an uncommon adverse reaction with numerous agents. It is a diagnosis of exclusion, and clinical signs and CSF findings vary greatly. The body of evidence regarding DIAM is largely in the form of anecdotal case reports and must be interpreted carefully bearing this in mind. The major categories of causative agents are nonsteroidal anti-inflammatory drugs, antimicrobials, intravenous immunoglobulin, intrathecal agents, vaccines and a number of other less frequently reported agents. There appears to be an association between DIAM and connective tissue disease, particularly systemic lupus erythematosus, and ibuprofen. There are 2 major proposed mechanisms for DIAM. The first involves direct irritation of the meninges by intrathecal administration of the drug, and the second involves immunological hypersensitivity to the drug, most likely type III and type IV hypersensitivity. Recognition and diagnosis of DIAM is important, as it is treatable by withdrawal of the drug and recurrence is prevented. The outcome of DIAM is generally good, usually without long term sequelae. This article describes the case reports of DIAM in the current literature and discusses the diagnosis and management of this rare complication.

The Challenge of Drug-Induced Aseptic Meningitis

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.

Drug-induced meningitis.

Preview Drug-induced aseptic meningitis is an unusual adverse reaction associated with a number of medications. In this report, the authors present a case related to use of trimethoprim- sulfamethoxazole and summarize the available data regarding various proposed mechanisms of drug-induced meningitis. The usual clinical presentation and course of the disorder are discussed.

Drug-induced aseptic meningitis

Drug-induced aseptic meningitis is a syndrome that should be considered in the differential diagnosis of acute and recurrent aseptic meningitis. It has been observed in all age-groups and can occur following the use of a wide spectrum of pharmaceutical agents. Presumptive diagnosis is made by demonstrating the resolution of symptoms after drug withdrawal, and definitive diagnosis is made by conducting a drug rechallenge. Fortunately, the syndrome is usually benign and resolves quickly following drug cessation.

Drug-induced neurological disorders

Epidemiology and clinical significance pathomechanism of drug-induced neurological disorders drug-induced encephalopathies drug-induced disorders of consciousness drug-induced neuropsychiatric disorders drug-induced headaches drug-induced seizures drug-induced movement disorders drug-induced disorders of cranial nerves and special senses drug-induced peripheral neuropathies drug-induced neuromuscular disorders drug-induced myopathies diseases of the spine and spinal cord drug-induced cerebellar disorders drug-induced aseptic meningitis drug-induced benign intracranial hypertension disorders of the autonomic nervous system drug-induced sleep disorders eosinophilia myalgia syndrome serotonin syndrome drug-induced Guillain-Barr syndrome neurolpetic malignant syndrome subacute myelo-optico-neuropathy (SMON) drug-induced pituitary disorders.