Drug-induced aseptic meningitis

Background

Etiologies

• NSAIDs: ibuprofen (most common), diclofenac, naproxen, sulindac
• Antibiotics: cotrimoxazole, cephalosporins, amoxicillin, ciprofloxacin
• Antiepileptics: lamotrigine, carbamazepine
• Chemotherapy: cetuximab, intrathecal chemotherapy
• Immunosuppression: methotraxate, azathioprine, TNF-alpha inhibitors (adalimumab, infliximab, etanercept)
• Other: IVIg

Clinical Presentation

• Most commonly associated with ibuprofen, particularly in the context of underlying rheumatologic disease (particularly SLE)
• Onset of headache, fever, and meningismus within 48 hours of drug exposure, and resolution on withdrawal of drug
• Recurs with repeated exposure to the drug
• CSF shows neutrophilic or lymphocytic pleocytosis, elevated protein, and normal glucose

Diagnosis

• Clinical suspicion, with exclusion of other causes

Management

• Avoidance of the offending medication