Drug-induced meningitis: A review of the literature and comparison with an historical cohort of viral meningitis cases

Kalmi, Galith; Javeri, Florian; Vanjak, Anthony; Kirren, Quentin; Green, Andrew; Jarrin, I.; Lloret‐Linares, Célia

doi:10.1016/j.therap.2020.03.001

Cited by 10 publications

(20 citation statements)

References 113 publications

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“…Most often presenting clinically with the classical signs of meningitis or meningoencephalitis -fever, headache, meningism, and sometimes rash -DIAM is difficult to distinguish from infectious meningitis. 2 Recent research comparing the clinical and biological characteristics of DIAM and viral encephalitis suggests DIAM CSF generally shows neutrophilic pleocytosis, normal-to-low glucose, and increased protein, 3 as was the case with this patient. While neutrophilic pleocytosis is indicative of DIAM, partially treated bacterial meningitis and fungal meningitis must be excluded.…”

Section: Diagnosissupporting

confidence: 51%

Pathogenesis and predisposing factors in drug-induced aseptic meningitis: A case study

Ghosh¹

2022

NZMSJ

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Case PresentationA 61-year-old European man was admitted with two days of progressive high-grade fevers, neck stiffness, and headache. He started taking ibuprofen 400 mg three times a day for an ankle sprain 24 hours prior to his symptoms. He was screened for genitourinary, gastro-intestinal, and cardiorespiratory causes for his symptoms, which were negative.Collateral history revealed previous admissions with meningitis but suggested his current presentation was more severe than the previous admissions in 2012 and 2016, neither of which yielded identifiable pathogens on lumbar puncture, despite showing neutrophilic pleocytosis. He had also taken non-steroidal anti-inflammatories (NSAIDs) prior to those admissions.The patient had no other significant medical history and took no regular medications. He was a non-drinker, an ex-smoker (5 packyears), and normally independent in his activities of daily living.On examination, the patient was tremulous and flushed. His temperature was 38.2 o C. Kernig's and Brudzinski's signs were positive, and he complained of moderate photophobia in a well-lit room. No focal neurological signs were noted, and apart from his ankle, all systems examinations were unremarkable.Blood tests revealed mildly elevated inflammatory changes (C-reactive protein 8 mg/L and white cell count (WCC) 15.1x10 3 /µL). Liver, thyroid, and renal function tests were normal, as were electrolytes, B12, folate, creatine kinase, and lipase. Blood cultures, human immunodeficiency virus (HIV), and Treponemal serology were negative. Head imaging with computed tomography (CT) and magnetic resonance imaging (MRI) was normal, and a lumbar puncture showed a neutrophilic pleocytosis (WCC 67x10 6 /L; 54% neutrophils) with raised protein (820 mg/L) and normal glucose (2.8 mmol/L). Cerebrospinal fluid (CSF) cultures were sterile, and a polymerase chain reaction (PCR) panel was negative for herpes simplex virus 1 and 2, varicella zoster virus, Neisseria meningitidis, Streptococcus pneumoniae, Haemophilus influenzae, and enterovirus. There were no other sources of infection found through either a CT chest or echocardiogram.

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Section: Diagnosissupporting

confidence: 51%

Pathogenesis and predisposing factors in drug-induced aseptic meningitis: A case study

Ghosh¹

2022

NZMSJ

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“…Furthermore, in the present case, NIAM onset occurred within one day. Typically, drug-induced aseptic meningitis manifests within three days, although onset times vary widely [ 4 ]. A literature review also revealed that the onset of NIAM typically occurs within one to three days, consistent with the timing observed in our case.…”

Section: Discussionmentioning

confidence: 99%

“…Immunoglobulin preparations, antimicrobial agents, vaccines, and nonsteroidal anti-inflammatory drugs (NSAIDs), commonly used in clinical practice, are some of the agents that reportedly induce aseptic meningitis [ 2 , 3 ]. NSAID-induced aseptic meningitis caused by NSAIDs is frequently reported [ 4 ]. The causative agents of NSAID-induced aseptic meningitis (NIAM) include ibuprofen, sulindac, naproxen, diclofenac, rofecoxib, and celecoxib, with ibuprofen being the most frequently reported [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Elderly Woman With No Autoimmune Disease With Aseptic Meningitis Caused by Celecoxib

Takigawa,

Tanaka,

Kobayashi

et al. 2024

Cureus

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Nonsteroidal anti-inflammatory drug (NSAID)-induced aseptic meningitis (NIAM) is frequently reported in patients with autoimmune disease. Ibuprofen-induced NIAM is the most common case report of NIAM. We report a patient without autoimmune disease who developed NIAM following oral celecoxib administration. A literature review and survey of cases registered in the Japanese Adverse Drug Event Report (JADER) database is also provided. A 73-year-old woman with no autoimmune disease developed a headache the day after taking celecoxib, and NIAM was suspected. The headache resolved quickly following celecoxib discontinuation. Although lumbar puncture was not available in this case, bacterial or viral meningitis was negative, and NIAM could not be ruled out. This case involved an older adult patient without an autoimmune disease, with celecoxib as the causative NSAID. A literature review found numerous cases of autoimmune diseases in younger patients. To date, only one case of celecoxib-induced NIAM has been reported. Analysis of NIAM cases in JADER revealed an onset time of approximately three days. JADER analysis indicated that NIAM tended to occur immediately after administration, although the onset with cyclooxygenase-2 selective agents might be slower.

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“…Other differential diagnoses were considered; for example, drug-induced aseptic meningoencephalitis. This condition is a diagnosis of exclusion, which has been linked to NSAID use in rare cases [ 6 ]. Unfortunately, enterovirus testing was performed only in cerebrospinal fluid and no respiratory tract or fecal samples were collected.…”

Section: Discussionmentioning

confidence: 99%

Monkeypox virus-associated meningoencephalitis diagnosed by detection of intrathecal antibody production

Karin,

Ylva,

Sandra

et al. 2024

BMC Infect Dis

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Background In the 2022 mpox-outbreak most patients presented with mild symptoms. Central nervous system (CNS) involvement has previously been described as a rare and severe complication of mpox; however, diagnostic findings in cerebrospinal fluid (CSF) analysis and neuroimaging studies have only been reported in one case previously. Case presentation We report a previously healthy 37-year-old man with mpox complicated by encephalitis. He first presented with painful skin lesions and genital ulcers; polymerase chain reaction (PCR) from the lesions was positive for mpox. Twelve days later he was admitted with fever and confusion. Neuroimaging and CSF analysis indicated encephalitis. The CSF was PCR-negative for monkeypox virus but intrathecal antibody production was detected. He spontaneously improved over a few days course and recovered fully. Conclusions This case of mpox-associated encephalitis shows that CNS involvement in mpox infection may have a relatively mild clinical course, and that detection of intrathecal antibody production can be used to establish the diagnosis if CSF monkeypox virus-PCR is negative.

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Drug-induced meningitis: A review of the literature and comparison with an historical cohort of viral meningitis cases

Cited by 10 publications

References 113 publications

Pathogenesis and predisposing factors in drug-induced aseptic meningitis: A case study

Pathogenesis and predisposing factors in drug-induced aseptic meningitis: A case study

Elderly Woman With No Autoimmune Disease With Aseptic Meningitis Caused by Celecoxib

Monkeypox virus-associated meningoencephalitis diagnosed by detection of intrathecal antibody production

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