Amoxicillin-induced Aseptic Meningitis with Neutrophil Predominance

Leung, John S M; Wilson, Marion E.

doi:10.1016/j.jaci.2011.12.169

Cited by 2 publications

(1 citation statement)

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“…Year Main Symptoms Indication for Amoxicillin Czerwenka et al [22] 1999 Fever, headache, neck stiffness Pretibial Wound Jacobsson et al [23] 1999 * * Mateos et al [24] 2000 * * Wittmann et al [25] 2001 Photophobia, AMS, difficulty reading, difficulty finding things Sore throat Thaunat et al [26] 2003 Fever, extrapyramidal stiffness, confusion, coma Skin grafting for varicose ulcers Whyte et al [27] 2008 Fever, headache, chills, phonophobia Dental surgery Shahien et al [2] 2010 Fever, headache, chills, nuchal rigidity, phonophobia Dental and gingival inflammation Pietro-González et al [28] 2011 Fever, headache, photophobia Skin infection Leung et al [29] 2012 Fever, headache, nausea, vomiting Dental surgery Turk et al [6] 2016 Fever, headache, nuchal rigidity, myalgias, phonophobia, photophobia Genital infection Chu et al [30] 2018 Fever, headache, nausea, confusion Otitis media El Sheikh et al [31] 2018 Fluctuating consciousness, headache, blurry vision, skin rash Superinfection of chicken pox Alarcón et al [32] 2019 Fever, headache (2 cases) Dental infection, herpetic whitlow Sousa et al [8] 2020 Fever, headache Dental surgery * Article not available in English; AMS=altered mental status…”

Section: Authormentioning

confidence: 99%

Amoxicillin-Induced Meningoencephalitis: Case Report and Review of the Literature

Scherschinski¹,

Baudier²,

Mono³

et al. 2021

AJIM

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Amoxicillin is one of the most frequently prescribed antibiotics for common bacterial infections in the primary care setting. Although being considered one of the safest drugs, amoxicillin can induce a rare hypersensitivity reaction with direct leptomeningeal irritation leading to drug-induced aseptic meningoencephalitis (DIAM). Given its rare incidence and poorly elucidated risk factors, amoxicillin-induced aseptic meningoencephalitis remains a diagnostic challenge. We report here the case of an 82-year-old male who presented to our emergency department with fever and cellulitis on the left foot. Antibiotic therapy with amoxicillin-clavulanate was established. Two days after admission, the patient developed frontal headaches, nausea, photophobia, and nuchal rigidity, while remaining febrile. In addition, intermittent episodes of amnesic aphasia, confusion, and agitation were observed. Cerebrospinal fluid (CSF) analysis revealed mononuclear-predominant pleocytosis, without detecting a causative pathogen by culture or PCR screening. Repeated and focused exploration of the patient's medical history unraveled a similar episode of severe cephalgia with mononuclear-predominant pleocytosis on CSF analysis after the intake of amoxicillin-clavulanate 15 years before the current presentation. The combination of clinical signs for leptomeningeal irritation following ingestion of a distinct medication and the lack of evidence for a causative pathogen on CSF analysis, were suggestive of DIAM. DIAM is most commonly caused by nonsteroidal anti-inflammatory drugs, antibiotics and intravenous immunoglobulins. DIAM remains a diagnosis of exclusion. Its pathomechanism is still not completely understood. Our illustrative case emphasizes the key points of this rare but important diagnosis. In the context of our report, we review all published cases of amoxicillin-induced meningoencephalitis. Our case report may increase the awareness of this challenging diagnosis.

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Section: Authormentioning

confidence: 99%

Amoxicillin-Induced Meningoencephalitis: Case Report and Review of the Literature

Scherschinski¹,

Baudier²,

Mono³

et al. 2021

AJIM

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Amoxicillin-induced aseptic meningitis: clinical features, diagnosis and management

Fan,

He,

Sun

et al. 2023

Eur J Med Res

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Objectives The clinical features of aseptic meningitis associated with amoxicillin are unknown. The main objective of this study was to investigate the clinical characteristics of amoxicillin-induced aseptic meningitis (AIAM) and provide a reference for clinical diagnosis and treatment. Methods AIAM-related studies were collected by searching the relevant databases from inception to October 31, 2022. Results AIAM usually occurred 3 h to 7 days after amoxicillin administration in 13 males and 9 females. Twenty-one patients (95.5%) had recurrent AIAM with a total of 62 episodes. Fever (19 cases, 86.4%) and headache (18 cases, 81.8%) were the most common symptoms. Typical cerebrospinal fluid (CSF) findings were leukocytosis (100%) with lymphocytic predominance (14 cases, 63.6%), elevated protein (20 cases, 90.1%), normal glucose (21 cases, 95.5%) and negative culture (21 cases, 100%). Brain magnetic resonance imaging showed mild meningeal enhancement in one patient. The symptoms resolved mainly within 1–4 days after drug discontinuation in all patients. Conclusion Clinical attention should be given to the adverse effects of AIAM. The medication history of patients with suspected meningitis should be investigated to avoid unnecessary examination and antibiotic treatment.

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Amoxicillin-induced Aseptic Meningitis with Neutrophil Predominance

Cited by 2 publications

References 0 publications

Amoxicillin-Induced Meningoencephalitis: Case Report and Review of the Literature

Amoxicillin-Induced Meningoencephalitis: Case Report and Review of the Literature

Amoxicillin-induced aseptic meningitis: clinical features, diagnosis and management

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