Drug induced aseptic meningitis: Difference between revisions
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==References== | ==References== | ||
Moris, G, Garcia-Monco, JC. The | Moris, G, Garcia-Monco, JC. The Challenge of Drug-induced Aseptic Meningitis. Arch intern med. 1999 Jun 14; 159 (11): 1185-94 | ||
Nettis, E, Calogiuri, G, Colanardi, MC, Ferrannini, A, Tursi, A. Drug-induced | |||
Nettis, E, Calogiuri, G, Colanardi, MC, Ferrannini, A, Tursi, A. Drug-induced Aseptic Meningitis. Current Drug Targets - Immune, Endocrine & Metabolic Disorders, 2003, 3, pp. 143-149 | |||
Revision as of 19:41, 1 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
Clinical presentation
- Headache
- Fever
- Nuchal rigidity
- Nausea/vomiting
- General malaise
- Altered mental status
- Less common symptoms include rash, arthralgia, myalgia, facial edema
Diagnosis
- 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
Treatment
- Discontinuation of offending agent
References
Moris, G, Garcia-Monco, JC. The Challenge of Drug-induced Aseptic Meningitis. Arch intern med. 1999 Jun 14; 159 (11): 1185-94
Nettis, E, Calogiuri, G, Colanardi, MC, Ferrannini, A, Tursi, A. Drug-induced Aseptic Meningitis. Current Drug Targets - Immune, Endocrine & Metabolic Disorders, 2003, 3, pp. 143-149