Drug induced aseptic meningitis: Difference between revisions
| 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== | ==Causes== | ||
*[[NSAIDs]] | *[[NSAIDs]] | ||
Revision as of 18:53, 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