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

Abstract

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.

Trimethoprim-Sulfamethoxazole-Induced Aseptic Meningitis: A New Approach

“…There are several other medications (DIAM) already reported in the medical literature with this similar complication: NSAIDs, metronidazole, infliximab, lamotrigine, and intravenous immunoglobulins. Other causes of aseptic meningitis include malignancies (leukemias), viruses (CMV), autoimmune diseases (Bechet), and tick-borne borne diseases (Lyme) [ 4 - 5 ]. Therefore, our patient underwent a full workup of these diseases, which all came back negative.…”

Aseptic Meningitis Secondary to Antibiotic Therapy

“…Infectious etiology should always be excluded. Bacterial, viral, and fungal pathogens are most commonly associated, but autoimmune disease, malignancy, and less typical infections like spirochetes, mycobacteria, and parasites have also been reported in literature [1]. Symptoms generally include fever, neck stiffness, headache, photophobia, nausea, vomiting, and confusion [8].…”

“…Symptoms generally include fever, neck stiffness, headache, photophobia, nausea, vomiting, and confusion [8]. In some cases, life-threatening presentations like seizures, hypotension, and respiratory failure have been documented [1,9]. CSF analysis may be indistinguishable from bacterial meningitis and empirical therapy with IV antibiotics and antiviral is warranted while awaiting cultures.…”

“…Aseptic meningitis is a presentation of meningeal inflammation with clinical and laboratory findings without evidence of bacterial infection confirmed by cerebrospinal fluid (CSF) culture. The most common cause is enteroviruses, however, less common causes include autoimmune disease, leukemia, vaccines, and drugs [1]. Drug-induced aseptic meningitis (DIAM) is a rare adverse reaction believed to have an immunehypersensitivity nature affecting the central nervous system [2].…”

Clinical Characteristics, Diagnosis, and Management of Aseptic Meningitis Induced by Trimethoprim-Sulfamethoxazole

“… 1 Enteroviruses are the most common etiologies of aseptic meningitis, while other less common etiologies include autoimmune diseases, leukemia, vaccines and drugs. 2 Drug-induced aseptic meningitis (DIAM) is a rare disease that occurs mainly in women and patients with autoimmune disorders. The most commonly involved drugs are nonsteroidal anti-inflammatory drugs (NSAIDs), antibiotics, intravenous immunoglobulins, monoclonal antibodies and intrathecal drugs.…”