Drug‐induced aseptic meningitis: 329 cases from the French pharmacovigilance database analysis

Bihan, Kévin; Weiss, Nicolas; Funck‐Brentano, Christian; Lebrun‐Vignes, Bénédicte

doi:10.1111/bcp.14073

Cited by 24 publications

(27 citation statements)

References 18 publications

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“…The pathogenic mechanism of NSAID-induced aseptic meningitis and meningism remain unclear. Some clinicians pro-posed that this adverse effect is consistent with the hypersensitivity [12] and meningeal irritation theory [2,9]. Initially, we had no clue whether it was a case of meningoencephalitis or drug-induced aseptic meningitis.…”

Section: Discussionmentioning

confidence: 80%

“…rheumatologic disorders, systemic lupus erythematous, and mixed connective tissue disorder [3,4,6]. French pharmacovigilance database on drug-induced aseptic meningitis [9] provided healthcare professionals with the list of drugs which were reported to have caused aseptic meningitis and the presenting signs and symptoms. Although many of the cases involved NSAIDs use in patients with underlying immunerelated disorders, this adverse event has also been reported, similar to our case, in previously healthy individuals [10,11].…”

Section: Discussionmentioning

confidence: 99%

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A Case of Probable Diclofenac-Induced Acute Meningism in a Healthy Adolescent

et al. 2020

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Non-steroidal anti-inflammatory drugs (NSAIDs) and paracetamol are the common analgesics used in children who experience mild to moderate pain. NSAIDs-related case of aseptic meningitis or meningism in healthy adolescent is relatively uncommon. We report a case of an 11-year-old boy with underlying bronchial asthma who had recent intake of three doses of diclofenac (50 mg), presented with signs and symptoms mimicking acute meningism. The boy initially presented to the emergency department after he experienced throbbing headache, dizziness, nausea and persistent vomiting for about 15 times per day for the past 2 days. He did not report presence of any auditory or visual hallucination; however, he claimed to have a bit of photophobia. Signs and symptoms occurred soon after the second dose of diclofenac. Besides, he was also taking oral antibiotic Augmentin for his left epididymo-orchitis problem and famotidine for prevention of gastritis prescribed by general practitioner. Vital signs were normal, and review of systems did not find any abnormality. Neurological assessment found no significant deficit, no cerebellar sign, negative Babinski test and no sign of meningism. Patient did not have frequent fall, head trauma or any family history of neurological diseases. A provisional diagnosis of meningoencephalitis was made after review by specialist. The parents of the boy did not give consent to conduct spinal tap. Upon further examination, urgent contrast-enhanced computed tomography was done and clinical neurological assessment was not suggestive of meningoencephalitis. Antibiotics treatment for meningoencephalitis was stopped 12 h after hospitalization. Although this case was not diagnosed as aseptic meningitis, timeline of diclofenac intake, onset of symptoms, clinical manifestations and quick resolution symptoms after drug discontinuation were supportive of a temporal relationship between diclofenac and meningism. Paracetamol was given to relieve the headache, vomiting resolved after one dose of intravenous metoclopramide plus ranitidine, and patient was well throughout the 5 days in ward. This adverse effect of NSAIDs is very rare and continuous effort in pharmacovigilance can help to raise awareness among clinicians.

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Section: Discussionmentioning

confidence: 80%

Section: Discussionmentioning

confidence: 99%

A Case of Probable Diclofenac-Induced Acute Meningism in a Healthy Adolescent

et al. 2020

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“…HMGB1 (high-mobility group box 1), released or secreted by necrotic brain cells, may act as an early in ammation trigger inducing the local recruitment of pro-in ammatory cytokines, independently of BBB alterations. [6] An increase in the levels of neuronal speci c enolase, protein S100B, T-tau protein, neuro lament were also reported [6,31].Finally, CSF abnormalities can be induced by many factors including drugs, spinal cord compression, diabetes, and polyradiculoneuritis [32]. In uence of systemic and neuro in ammation after CA on CSF protein level could not be further explored because of the non-availability of albumin CSF/blood ratio or speci c MRI exploration to assess the BBB function [33,34].…”

Section: Discussionmentioning

confidence: 90%

Diagnostic and Prognostic Contribution of Cerebrospinal Fluid Analysis After Cardiac Arrest

Paul¹,

Benghanem²,

Merceron³

et al. 2020

Preprint

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Background: Lumbar puncture is among the investigations used to determine the aetiology and prognosis of cardiac arrest, despite a dearth of data on its performance. We aimed to assess the diagnostic and prognostic performance of lumbar puncture after cardiac arrest. Methods: We retrospectively studied data from prospectively established databases of consecutive patients who were admitted to two French ICUs in 2007-2016 with sustained return of spontaneous circulation (ROSC) after cardiac arrest and who underwent lumbar puncture as an aetiological investigation. Results: Of 1984 patients with sustained ROSC, 65 (3.3%) underwent lumbar puncture and were included. Lumbar puncture identified a neurological cause of cardiac arrest in 6/65 (9%) patients, including 5 with neurologic prodromal symptoms before cardiac arrest and 4 with the lumbar puncture done post-mortem. Lumbar puncture performed before death showed nonspecific cerebrospinal fluid abnormalities in 37/53 (69.8%) patients. By univariate analysis, factors significantly associated with cerebrospinal fluid abnormalities were shorter no-flow time (0 min [0-3] versus 4 min [2-10], p=0.004) and post-resuscitation shock (26 [70%] versus 5 [31%], p<0.01). Presence of cerebrospinal fluid abnormalities was non significantly associated with poorer outcomes (CPC 3-4-5) (p=0.06). Conclusions: Lumbar puncture, although rarely performed, can contribute to the aetiological diagnosis of cardiac arrest. As a second-line investigation, it identified the cause in 9% of our patients. Nonspecific cerebrospinal fluid abnormalities are common after cardiac arrest, perhaps due to blood-brain barrier disruption, and may carry prognostic significance.

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“…The most commonly identified medication in DIAM is the nonsteroidal anti-inflammatory drugs (NSAIDs) with ibuprofen being the most likely observed NSAIDs among others. Other medications were observed including but not limited to intravenous immunoglobulin (IVIG), anticonvulsants, monoclonal antibodies, allopurinol, azathioprine, vaccines, and antimicrobial drugs [6–8].…”

Section: Discussionmentioning

confidence: 99%

“…Other infectious etiologies include mycobacterial, fungi, spirochetes, and parasites, and least possible etiologies are related to medications, malignancy, autoimmune disorder, and vaccines [2]. Drug-induced aseptic meningitis (DIAM) has been reported in the literature from different classes of medications [3–8]. Here, I report a case of recurrent DIAM related to TMP/SMX in a patient with no previous history of sulfamethoxazole allergy.…”

Section: Introductionmentioning

confidence: 99%

Trimethoprim-Sulfamethoxazole-Induced Aseptic Meningitis: A Rare Presentation of Commonly Used Antibiotic

Agabawi

2019

Case Reports in Infectious Diseases

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Drug-induced aseptic meningitis is a rare medical condition with trimethoprim-sulfamethoxazole being one of the most common antimicrobial agents associated with it. Here, I report a case of a 56-year-old male who presented to a health care facility with shock and meningitis-like syndrome in two occasions, one year apart following an exposure to trimethoprim-sulfamethoxazole for treatment of skin/soft tissue infection. Investigations did not reveal an infectious etiology in the two presentations. The patient improved with supportive care and withdrawal of the offending agent. In the two admissions, the patient improved following stopping the offending drug in addition to supportive care. The diagnosis of trimethoprim-sulfamethoxazole-induced aseptic meningitis was the most likely explanation for this case. Trimethoprim-sulfamethoxazole-induced aseptic meningitis is rare although it is a life-threatening side effect of TMP/SMX; therefore, the clinicians should keep the diagnosis of drug-induced aseptic meningitis in the differential diagnosis of aseptic meningitis in the appropriate clinical setting as early withdrawal of the culprit drug and supportive measurements will lead to early recovery.

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Drug‐induced aseptic meningitis: 329 cases from the French pharmacovigilance database analysis

Cited by 24 publications

References 18 publications

A Case of Probable Diclofenac-Induced Acute Meningism in a Healthy Adolescent

A Case of Probable Diclofenac-Induced Acute Meningism in a Healthy Adolescent

Diagnostic and Prognostic Contribution of Cerebrospinal Fluid Analysis After Cardiac Arrest

Trimethoprim-Sulfamethoxazole-Induced Aseptic Meningitis: A Rare Presentation of Commonly Used Antibiotic

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