Drug induced aseptic meningitis: Difference between revisions
(Created page with "==Background== *Abbreviation: DIAM *Two proposed mechanisms **Direct meningeal irritation by intrathecal drug **Hypersensitivity reaction to drug (type III and IV)") |
No edit summary |
||
| (16 intermediate revisions by 3 users not shown) | |||
| Line 4: | Line 4: | ||
**Direct meningeal irritation by intrathecal drug | **Direct meningeal irritation by intrathecal drug | ||
**Hypersensitivity reaction to drug (type III and IV) | **Hypersensitivity reaction to drug (type III and IV) | ||
*Higher predominance in SLE and female gender | |||
===Causes=== | |||
*[[NSAIDs]] | |||
**Most common cause | |||
*[[Antibiotics]] | |||
**Sulfamethizole | |||
**[[TMP-SMX]] | |||
**[[Isoniazid]] | |||
**[[Ciprofloxacin]] | |||
**[[Amoxicillin]] | |||
**[[Gentamicin]] | |||
**[[Penicillin]] | |||
**[[Metronidazole]] | |||
**[[Cephalosporins]] | |||
**[[Pyrazinamide]] | |||
*Immunoregulating agents | |||
**IVIGs | |||
**OKT3 monoclonal antibodies | |||
*Misc | |||
**Sulfasalazine | |||
**[[Carbamazepine]] | |||
**[[Azathioprine]] | |||
**Indinavir | |||
**[[Valacyclovir]] | |||
**[[Ranitidine]] | |||
**[[Famotidine]] | |||
**Methylprednisolone acetate | |||
**[[Allopurinol]] | |||
==Clinical Freatures== | |||
''Symptoms generally occur within 24-48 hours after taking drug'' | |||
*[[Headache]] | |||
*[[Fever]] | |||
*Nuchal rigidity | |||
*[[Nausea/vomiting]] | |||
*General malaise | |||
*[[Altered mental status]] | |||
*Less common symptoms include rash, arthralgia, myalgia, facial edema | |||
==Differential Diagnosis== | |||
{{Headache DDX}} | |||
==Evaluation== | |||
*Drug history with focus on time of ingestion and symptom onset | |||
*CSF studies | |||
**Pleiocytosis (primarily neutrophilic) | |||
**Elevated protein levels | |||
**Normal glucose | |||
**Negative cultures | |||
*Challenge test with suspected drug | |||
**Only confirmatory test | |||
**Requires informed written consent | |||
**Due to associated risk, should only be done if suspected drug is irreplaceable | |||
==Management== | |||
*Discontinuation of offending agent | |||
==Disposition== | |||
==Outcome== | |||
*Generally good, usually with no long term sequelae | |||
==See Also== | |||
*[[Meningitis]] | |||
==References== | |||
<references/> | |||
[[Category:ID]] | |||
[[Category:Pharmacology]] | |||
Latest revision as of 16:21, 12 September 2017
Background
- Abbreviation: DIAM
- Two proposed mechanisms
- Direct meningeal irritation by intrathecal drug
- Hypersensitivity reaction to drug (type III and IV)
- Higher predominance in SLE and female gender
Causes
- NSAIDs
- Most common cause
- Antibiotics
- Immunoregulating agents
- IVIGs
- OKT3 monoclonal antibodies
- Misc
- Sulfasalazine
- Carbamazepine
- Azathioprine
- Indinavir
- Valacyclovir
- Ranitidine
- Famotidine
- Methylprednisolone acetate
- Allopurinol
Clinical Freatures
Symptoms generally occur within 24-48 hours after taking drug
- Headache
- Fever
- Nuchal rigidity
- Nausea/vomiting
- General malaise
- Altered mental status
- Less common symptoms include rash, arthralgia, myalgia, facial edema
Differential Diagnosis
Headache
Common
Killers
- Meningitis/encephalitis
- Myocardial ischemia
- Retropharyngeal abscess
- Intracranial Hemorrhage (ICH)
- SAH / sentinel bleed
- Acute obstructive hydrocephalus
- Space occupying lesions
- CVA
- Carbon monoxide poisoning
- Basilar artery dissection
- Preeclampsia
- Cerebral venous thrombosis
- Hypertensive emergency
- Depression
Maimers
- Giant cell arteritis of temporal artery (temporal arteritis)
- Idiopathic intracranial hypertension (Pseudotumor Cerebri)
- Acute Glaucoma
- Acute sinusitis
- Cavernous sinus thrombosis or cerebral sinus thrombosis
- Carotid artery dissection
Others
- Mild traumatic brain injury
- Trigeminal neuralgia
- TMJ pain
- Post-lumbar puncture headache
- Dehydration
- Analgesia abuse
- Various ocular and dental problems
- Herpes zoster ophthalmicus
- Herpes zoster oticus
- Cryptococcosis
- Febrile headache (e.g. pyelonephritis, nonspecific viral infection)
- Ophthalmoplegic migraine
- Superior Vena Cava Syndrome
Aseptic Meningitis
- Viral
- Tuberculosis
- Lyme disease
- Syphilis
- Leptospirosis
- Fungal (AIDS, transplant, chemotherapy, chronic steroid use)
- Noninfectious
Evaluation
- Drug history with focus on time of ingestion and symptom onset
- CSF studies
- Pleiocytosis (primarily neutrophilic)
- Elevated protein levels
- Normal glucose
- Negative cultures
- Challenge test with suspected drug
- Only confirmatory test
- Requires informed written consent
- Due to associated risk, should only be done if suspected drug is irreplaceable
Management
- Discontinuation of offending agent
Disposition
Outcome
- Generally good, usually with no long term sequelae