View source for Drug induced aseptic meningitis

==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]]
**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]]