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Ko AWK, Ghaffari-Rafi A, Chan A, Harris WB, Imasa A, Liow KK, Viereck J. A Case Report of Antibiotic-Induced Aseptic Meningitis in Psoriasis. HAWAI'I JOURNAL OF HEALTH & SOCIAL WELFARE 2021; 80:129-133. [PMID: 34195619 PMCID: PMC8237324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Although frequently prescribed, certain antibiotics such as trimethoprim-sulfamethoxazole carry the risk of a rare yet life-threatening adverse effect, termed drug-induced aseptic meningitis. Morbidity can be avoided if the medication is identified and discontinued. Patients in reported cases tend to be female and have an autoimmune disease or prior adverse reaction to the offending agent. As a rare and poorly characterized condition, the subset of patients using antibiotics at risk for aseptic meningitis remains unclear; hence, cataloging these adverse events remains critical for better elucidating the disease. Here, we report a 62-year-old man with psoriasis and no prior history of sulfa allergy, who presented with a sudden onset of fever, chills, vomiting, and muscle aches 5 hours after taking single doses of trimethoprim-sulfamethoxazole and ciprofloxacin. Common infectious causes were ruled out, and his medications were discontinued. Despite initial symptom resolution with discontinuation, the patient neurologically deteriorated over the next two days before eventually recovering with supportive care. This case highlights the variable presentation of drug-induced aseptic meningitis. In contrast to previous reports of drug-induced aseptic meningitis, our patient was male, older than the median age of 40 years, and did not have a prior adverse reaction to the antibiotic. Furthermore, to the best of our knowledge, we report a possible case of antibiotic-induced aseptic meningitis in a patient with psoriasis. Lastly, the case emphasizes not only the value of a thorough medication history but also the importance of recognizing that patients may deteriorate in the first 48 hours before resolution.
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Affiliation(s)
- Andrew Wai Kei Ko
- John A. Burns School of Medicine, University of Hawai‘i at Mānoa, Honolulu, HI (AWKK, AG, WBH, AI, KK, JV)
| | - Arash Ghaffari-Rafi
- John A. Burns School of Medicine, University of Hawai‘i at Mānoa, Honolulu, HI (AWKK, AG, WBH, AI, KK, JV)
| | - Alvin Chan
- University of California Riverside School of Medicine, Riverside, CA (AC)
| | - William B. Harris
- John A. Burns School of Medicine, University of Hawai‘i at Mānoa, Honolulu, HI (AWKK, AG, WBH, AI, KK, JV)
| | - Arcelita Imasa
- John A. Burns School of Medicine, University of Hawai‘i at Mānoa, Honolulu, HI (AWKK, AG, WBH, AI, KK, JV)
| | - Kore Kai Liow
- John A. Burns School of Medicine, University of Hawai‘i at Mānoa, Honolulu, HI (AWKK, AG, WBH, AI, KK, JV)
- Hawai‘i Pacific Neuroscience Institute, Honolulu, HI (KK, JV)
- John A. Burns School of Medicine, Clinical and Translational Research, Department of Quantitative Health Sciences, University of Hawai‘ at Mānoa, Honolulu, HI (KK, JV)
| | - Jason Viereck
- John A. Burns School of Medicine, University of Hawai‘i at Mānoa, Honolulu, HI (AWKK, AG, WBH, AI, KK, JV)
- Hawai‘i Pacific Neuroscience Institute, Honolulu, HI (KK, JV)
- John A. Burns School of Medicine, Clinical and Translational Research, Department of Quantitative Health Sciences, University of Hawai‘ at Mānoa, Honolulu, HI (KK, JV)
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Kalmi G, Javeri F, Vanjak A, Kirren Q, Green A, Jarrin I, Lloret-Linares C. Drug-induced meningitis: A review of the literature and comparison with an historical cohort of viral meningitis cases. Therapie 2020; 75:605-615. [PMID: 33187718 DOI: 10.1016/j.therap.2020.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 01/27/2020] [Accepted: 03/31/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Drug-induced aseptic meningitis (DIAM) is potentially insufficiently considered by clinician, being of rare etiology, with there being no previously published exhaustive study describing its clinical and biological features. METHODS Two independent academic clinicians searched all the case reports of DIAM from 1995 until 15th April, 2017. The search was limited to studies performed in humans, published in English or French. Clinical and biological data of subjects were compared with those of patients with documented viral meningitis. RESULTS One hundred and fifty-one case reports fulfilled our inclusion criteria. Non-steroidal anti-inflammatory drugs were the commonest drug cause of AM n=49, followed by antibiotics n=46, biotherapy n=19 and finally immunomodulators n=15. The clinical and biological presentation of DIAM varies according to the causative etiological drug, especially with respect to the interval between exposure and presentation and cerebrospinal fluid (CSF) pleiocytosis. Clinical symptoms associated with meningitis were more prevalent in viral meningitis than in DIAM, except for fever and signs of encephalitis. Cerebrospinal fluid examination in DIAM reveals an increased CSF white cell count and an increased proportion of neutrophils and protein, compared with viral meningitis. DISCUSSION We present an extensive review of the DIAM case reports, and highlight their clinical and biological characteristics according to the drugs involved. While comparing for the first time their characteristics with those of viral meningitis, this review hopes in facilitate earlier diagnosis and management of DIAM in clinical practice.
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Affiliation(s)
- Galith Kalmi
- Assistance publique-hôpitaux de Paris, hôpital Lariboisière, therapeutic research unit, department of internal medicine, 75010 Paris, France
| | - Florian Javeri
- Assistance publique-hôpitaux de Paris, hôpital Lariboisière, therapeutic research unit, department of internal medicine, 75010 Paris, France
| | - Anthony Vanjak
- Assistance publique-hôpitaux de Paris, hôpital Lariboisière, therapeutic research unit, department of internal medicine, 75010 Paris, France
| | - Quentin Kirren
- Assistance publique-hôpitaux de Paris, hôpital Lariboisière, therapeutic research unit, department of internal medicine, 75010 Paris, France
| | - Andrew Green
- Yorkleigh surgery, Saint Georges Round, Cheltenham, Gloucestershire GL50 3ED, United Kingdom
| | - Irène Jarrin
- Assistance publique-hôpitaux de Paris, hôpital Lariboisière, therapeutic research unit, department of internal medicine, 75010 Paris, France
| | - Célia Lloret-Linares
- Assistance publique-hôpitaux de Paris, hôpital Lariboisière, therapeutic research unit, department of internal medicine, 75010 Paris, France.
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Foley RW, Tagg NT, Schindler MK, Fenton KM, Reich DS, Cortese I, Mowry EM. Recurrent natalizumab-related aseptic meningitis in a patient with multiple sclerosis. Mult Scler 2017. [PMID: 28639536 DOI: 10.1177/1352458517702533] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Natalizumab is a recombinant humanized monoclonal antibody that decreases T-cell migration into the central nervous system (CNS) through α4 integrin:adhesion-molecule inhibition, thereby increasing the risk for opportunistic CNS infection. Herein, we report a case of infusion-associated aseptic meningitis in a patient receiving natalizumab.
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Affiliation(s)
- Robert W Foley
- Department of Neurology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA; School of Medicine, University College Dublin, Dublin, Ireland
| | - Nathan T Tagg
- Division of Neuroimmunology and Neurovirology, National Institute of Neurological Disorder and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Matthew K Schindler
- Division of Neuroimmunology and Neurovirology, National Institute of Neurological Disorder and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Kaylan M Fenton
- Department of Neurology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Daniel S Reich
- Department of Neurology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA/Division of Neuroimmunology and Neurovirology, National Institute of Neurological Disorder and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Irene Cortese
- Division of Neuroimmunology and Neurovirology, National Institute of Neurological Disorder and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Ellen M Mowry
- Department of Neurology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
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Naitoh T, Yamamoto M, Kawakami K, Suzuki C, Naishiro Y, Yamamoto H, Takahashi H, Shinomura Y. [Case of systemic lupus erythematosus repeated with various allergic reactions by trimethoprim-sulfamethoxazole]. ACTA ACUST UNITED AC 2010; 32:492-8. [PMID: 20046017 DOI: 10.2177/jsci.32.492] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A 23-year-old Japanese woman was diagnosed with lupus nephritis on May 2007. The patient was prescribed 30 mg/day of prednisolone, but developed a pulmonary abscess and was admitted to Sapporo Medical University Hospital in March 2008. Antibiotics improved the symptoms. We prescribed trimethoprim-sulfamethoxazole as prophylaxis for pneumocystis pneumonia; however, the patient developed fever and thrombocytopenia with hyperferritinemia after a week of this prophylaxis. We considered that she was developing hemophagocytic syndrome, and administered methylprednisolone pulse therapy. The clinical findings soon improved. However, when the prophylaxis was restarted, the patient developed fever, headache, and anaphylaxis the same day. Symptomatic therapy resolved these symptoms after three days, but they recurred on recommencing trimethoprim-sulfamethoxazole. Analysis of the cerebrospinal fluid revealed aseptic meningitis. These episodes were thought to be induced by trimethoprim-sulfamethoxazole. As trimethoprim-sulfamethoxazole is frequently used as prophylaxis for pneumocystis infection in immunosuppressed patients, clinicians should be vigilant regarding the complications of this treatment, particularly the rare occurrence of aseptic meningitis and anaphylaxis.
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Affiliation(s)
- Takafumi Naitoh
- First Department of Internal Medicine, Sapporo Medical University School of Medicine
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Kluger N, Heroum C, Michot C, Guillot B, Bessis D. Migraine with aura induced by efalizumab. Clin Exp Dermatol 2009; 34:e401-2. [DOI: 10.1111/j.1365-2230.2009.03378.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Strober B, Berger E, Cather J, Cohen D, Crowley JJ, Gordon KB, Gottlieb A, Horn EJ, Kavanaugh AF, Korman NJ, Krueger GG, Leonardi CL, Menter A, Schwartzman S, Sobell JM, Young M. A series of critically challenging case scenarios in moderate to severe psoriasis: A Delphi consensus approach. J Am Acad Dermatol 2009; 61:S1-S46. [DOI: 10.1016/j.jaad.2009.03.017] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2008] [Revised: 03/10/2009] [Accepted: 03/16/2009] [Indexed: 12/27/2022]
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Affiliation(s)
- Peter In't Veld
- Department of Pathology, Brussels Free University, Brussels, Belgium.
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[What's new in clinical dermatology?]. Ann Dermatol Venereol 2008; 134 Suppl 1:8S3-15. [PMID: 18675139 DOI: 10.1016/s0151-9638(07)80556-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
For this What's new in clinical dermatology?, I have selected some important publications mainly in the field of the infectious dermatosis and drugs allergy. The Chikungunya virus which is responsible of several epidemics since 2005 seems to be a virus with a cutaneous tropism. Sexually transmitted diseases are still a public health problem and we shall review the situation for syphilis, lymphogranuloma venereum and the new dynamic profile of HIV in France. Lyme disease has been the subject of consensus conference in France and in the United States. Original clinical presentations in relation with infectious agent will be also presented. We shall give a large place to what I call the toxidermatology. During the year 2007, the role of gadolinium in the nephrogenic systemic fibrosis has been confirmed, many publications have reported the side effects of biotherapies on the skin and we shall emphasize the paradoxical of some of them. Hypersensitivity syndrome and notably the controversial role of viral reactivations has been reported. The relationship between psoriasis and metabolic syndrome or cardiovascular risks has been discussed since 2006. New clinical features have been described and will be presented during this session.
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Current awareness: Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2007. [DOI: 10.1002/pds.1376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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