Drug-induced aseptic meningitis
From IDWiki
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
