Trimethoprim-Sulfamethoxazole: Another Cause of Recurrent Meningitis

Haas, Erwin J.

doi:10.1001/jama.1984.03350030020014

Cited by 33 publications

(5 citation statements)

References 7 publications

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“…Drug-related aseptic meningitis has been reported with several agents [1,2,3,4,5,6,7,8]. TMP-SMX or TMP alone are the most recurrent [4,5,6,7,8], although it is not always clear if aseptic meningitis is associated with TMP alone, the TMP-SMX combination or either.…”

Section: Discussionmentioning

confidence: 99%

“…Cerebrospinal fluid findings on ICU admission of mildly elevated protein, glucose and cell count have previously been reported in patients affected by TMP-SMX aseptic meningitis [4,6]. Moreover River et al and Carrillo et al have pointed out that CSF analysis is not a reliable method to differentiate drug-induced meningitis from partially treated bacterial meningitis [7,8].…”

Section: Discussionmentioning

confidence: 99%

“…Aseptic meningitis is a rare, adverse drug reaction, reported in connection with non-steroidal anti-inflammatory agents (NSAIDs) and with miscellaneous drugs such as trimethoprim-sulfamethoxazole (TMP-SMX) or trimethoprim alone [1,2,3,4,5,6,7,8]. The most common clinical findings, reported in almost all cases, are fever, headache, stiffness and altered level of consciousness [1,2,3,4,5,6,7,8].…”

Section: Introductionmentioning

confidence: 99%

“…A direct relationship between symptoms and the total amount of drugs consumed or the number of times the patient was exposed to the drug has been described [4,5]. Meningeal symptoms subsided in almost all patients without sequelae a few days after drug withdrawal [1,2,3,4,5,6,7,8].…”

Section: Introductionmentioning

confidence: 99%

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Trimethoprim-sulfamethoxazole-induced aseptic meningitis: case report and literature review

Capra

Monza

Meazza

et al. 2000

Intensive Care Medicine

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Aseptic meningitis is a rare adverse drug reaction, reported with non-steroidal anti-inflammatory agents (NSAIDs) and with miscellaneous drugs such as trimethoprim-sulfamethoxazole (TMP-SMX). The most common clinical findings reported are fever, headache, stiffness and altered level of consciousness. We report a case of aseptic meningitis related to TMP-SMX ingestion that caused severe derangements of the patient's vital signs, requiring Intensive Care Unit admittance. The prompt diagnosis and discontinuation of the drug resulted in complete recovery. We examine the case according to the literature on this topic. We conclude that, since the signs and symptoms of this unusual drug reaction may mimic those of central nervous system infection, the clinician should consider this etiology when he is faced with a patient with suspected meningoencephalitis, especially if the latter has already been treated at home with unknown drugs. Further studies should investigate the pathogenetic mechanism of TMP-SMX-induced aseptic meningitis.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Trimethoprim-sulfamethoxazole-induced aseptic meningitis: case report and literature review

Capra

Monza

Meazza

et al. 2000

Intensive Care Medicine

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“…1 Antibiotics are probably underrecognized as etiologic agents of meningitis and must be considered also in the differential diagnosis of recurrent meningitis, particularly in relation to anatomical skull defects, parameningeal infectious foci, immunodeficiencies, and Mollaret meningitis. 45 The abrupt onset in some patients with DIAM may suggest intracranial bleeding, especially in patients with idiopathic thrombocytopenic purpura and low platelet counts. Computed tomographic scans can be used to rule out hemorrhage.…”

Section: Differential Diagnosismentioning

confidence: 99%

The Challenge of Drug-Induced Aseptic Meningitis

Morís¹,

1999

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Several drugs can induce the development of aseptic meningitis. Drug-induced aseptic meningitis (DIAM) can mimic an infectious process as well as meningitides that are secondary to systemic disorders for which these drugs are used. Thus, DIAM constitutes a diagnostic and patient management challenge. Cases of DIAM were reviewed through a MEDLINE literature search (up to June 1998) to identify possible clinical and laboratory characteristics that would be helpful in distinguishing DIAM from other forms of meningitis or in identifying a specific drug as the culprit of DIAM. Our review showed that nonsteroidal anti-inflammatory drugs (NSAIDs), antibiotics, intravenous immunoglobulins, and OKT3 antibodies (monoclonal antibodies against the T3 receptor) are the most frequent cause of DIAM. Resolution occurs several days after drug discontinuation and the clinical and cerebrospinal fluid profile (neutrophilic pleocytosis) do not allow DIAM to be distinguished from infectious meningitis. Nor are there any specific characteristics associated with a specific drug. Systemic lupus erythematosus seems to predispose to NSAID-related meningitis. We conclude that a thorough history on prior drug intake must be conducted in every case of meningitis, with special focus on those aforementioned drugs. If there is a suspicion of DIAM, a third-generation cephalosporin seems a reasonable treatment option until cerebrospinal fluid cultures are available.

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Complement Factor I Deficiency With Recurrent Aseptic Meningitis

Bonnin

Zeitz²,

Gewurz³

1993

Arch Intern Med

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Patients with deficiency of the complement regulatory protein factor I typically present with systemic pyogenic bacterial infections, including meningitis. We report a novel case with total deficiency of factor I in serum and plasma; the patient experienced nine consecutive episodes of aseptic meningitis within a 2-year period. There was no history of previous bacterial sepsis. Aseptic meningitis recurred despite attempted penicillin prophylaxis. Each episode resolved rapidly without sequelae, with or without antibiotic treatment. Serum complement profiles showed persistently low levels of C3, factor B, and factor H and undetectable factor I protein. Family complement studies could not be performed. Except for a minimally increased titer of antinuclear antibody, no other immunologic abnormality was detected. Results of an oral ibuprofen challenge were negative. We conclude that deficiency of factor I may predispose to aseptic, as well as pyogenic bacterial, meningitis.

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Trimethoprim-Sulfamethoxazole: Another Cause of Recurrent Meningitis

Cited by 33 publications

References 7 publications

Trimethoprim-sulfamethoxazole-induced aseptic meningitis: case report and literature review

Trimethoprim-sulfamethoxazole-induced aseptic meningitis: case report and literature review

The Challenge of Drug-Induced Aseptic Meningitis

Complement Factor I Deficiency With Recurrent Aseptic Meningitis

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