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Nguyen TP, Kant I, Cartagena A, Kim JH. Drug-induced aseptic meningitis after an interlaminar lumbar epidural steroid injection. Pain Pract 2024; 24:670-672. [PMID: 38108661 DOI: 10.1111/papr.13333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
BACKGROUND This case report describes a rare instance of drug-induced aseptic meningitis after an interlaminar lumbar epidural steroid injection. CASE PRESENTATION A 74 year-old female patient presented to the ED post-procedure day three after an L4-L5 interlaminar lumbar epidural steroid injection with fever, nausea, and vomiting. The patient had previously undergone numerous lumbar epidurals without complications and used identical medications, which included 1% lidocaine, iohexol contrast, methylprednisolone (Depo-medrol), and normal saline. Pertinent labs included a WBC of 15,000 cells/μL. Lumbar MRI revealed L4-S1 aseptic arachnoiditis. Two bone scans with Gallium and T-99 confirmed no infectious process. The patient then had a second admission months later with similar presenting symptoms and hospital course after repeating the lumbar epidural steroid injection. Lumbar MRI and CSF studies confirmed aseptic meningitis. CONCLUSION This patient's repeated admissions from aseptic meningitis were likely caused by irritation of the meningeal layers from a medication used during the procedure.
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Affiliation(s)
- Trong P Nguyen
- Department of Anesthesia, Perioperative and Pain Medicine, Mount Sinai West-Morningside Hospitals, New York City, New York, USA
| | - Ishu Kant
- Department of Anesthesia, Perioperative and Pain Medicine, Mount Sinai West-Morningside Hospitals, New York City, New York, USA
| | - Alec Cartagena
- Department of Anesthesia, Perioperative and Pain Medicine, Mount Sinai West-Morningside Hospitals, New York City, New York, USA
| | - Jung H Kim
- Department of Anesthesia, Perioperative and Pain Medicine, Mount Sinai West-Morningside Hospitals, New York City, New York, USA
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2
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Al-Khateeb W, Jarad J, Kim Y, Battisti R. Long-term nivolumab treatment possibly associated with aseptic meningitis. BMJ Case Rep 2024; 17:e258141. [PMID: 38367991 PMCID: PMC10875536 DOI: 10.1136/bcr-2023-258141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2024] Open
Abstract
Nivolumab is a programmed death-1 receptor blocker within the family of medications called immune checkpoint inhibitors (ICIs). Although generally well tolerated, cases of immune-related adverse events (irAEs) have been reported. We present a case of a man being treated with nivolumab for renal cell carcinoma who presented to the emergency department with problems of headache, fever and disorientation. After extensive evaluation, a diagnosis of immunotherapy-induced aseptic meningitis was considered more probable than infectious. Due to stable clinical status, no treatment was initiated, and the patient's condition improved spontaneously. The patient was discharged home. To date, only a handful of prior cases of nivolumab-induced meningitis have been reported. Our case demonstrates that irAEs can occur years after the initiation of ICIs. This was a milder presentation of a neurological irAE that resolved spontaneously with watchful waiting, showing that irAEs are likely an evolving spectrum of disease for which clinicians should be aware.
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Affiliation(s)
- Wasef Al-Khateeb
- College of Medicine, Department of Internal Medicine, Central Michigan University, Saginaw, Michigan, USA
| | - John Jarad
- College of Medicine, Department of Internal Medicine, Central Michigan University, Saginaw, Michigan, USA
| | - Yuri Kim
- College of Medicine, Department of Internal Medicine, Central Michigan University, Saginaw, Michigan, USA
| | - Robert Battisti
- College of Medicine, Department of Internal Medicine, Central Michigan University, Saginaw, Michigan, USA
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3
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Kato Y, Osada T, Araki N, Takahashi S. Aseptic Meningitis after BNT-162b2 COVID-19 Vaccination: Case Report and Literature Review. Keio J Med 2023; 72:102-105. [PMID: 37743529 DOI: 10.2302/kjm.2022-0034-cr] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
We encountered a-27-year-old female patient who developed refractory severe headache and photophobia after the first dose of COVID-19 vaccine. Despite her prior history of migraine, we diagnosed COVID-19 vaccine-induced aseptic meningitis. Symptoms were significantly resolved after methylprednisolone therapy. On reviewing the literature, we could find only nine similar cases, with over half of them affecting women aged 20-40 years. Although uncommon, aseptic meningitis should be suspected in patients with persistent or delayed onset of headache following COVID-19 vaccination.
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Affiliation(s)
- Yuji Kato
- Department of Neurology and Cerebrovascular Medicine, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Takashi Osada
- Department of Neurology and Cerebrovascular Medicine, Saitama Medical University International Medical Center, Hidaka, Japan
| | | | - Shinichi Takahashi
- Department of Neurology and Cerebrovascular Medicine, Saitama Medical University International Medical Center, Hidaka, Japan
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Ng TTW, Davel S, O’Connor KD. Sulfasalazine-Induced Delayed Hypersensitivity Reaction Presenting as Fever, Aseptic Meningitis, and Mesenteric Panniculitis in a Patient with Seronegative Arthritis. Am J Case Rep 2023; 24:e941623. [PMID: 37924204 PMCID: PMC10630587 DOI: 10.12659/ajcr.941623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 09/26/2023] [Accepted: 09/12/2023] [Indexed: 11/06/2023]
Abstract
BACKGROUND An 82-year-old woman presented with acute pyrexial illness and mesenteric panniculitis and developed biochemical aseptic meningitis (cerebrospinal fluid pleocytosis with no identifiable pathogen). Investigation determined her illness was likely a delayed hypersensitivity reaction caused by sulfasalazine. Sulfasalazine-induced aseptic meningitis is a rare condition often diagnosed late in a patient's admission owing to initial non-specific illness symptomatology requiring the exclusion of more common "red flag" etiologies, such as infection and malignancy. CASE REPORT An 82-year-old woman with a history of recurrent urinary tract infections and seronegative arthritis presented with a 3-day history of fatigue, headache, dyspnea, and lassitude. On admission, she was treated as presumed sepsis of uncertain source owing to pyrexia and tachycardia. Brain computer tomography (CT) revealed no acute intracranial abnormality. Furthermore, CT of the chest, abdomen, and pelvis did not reveal any source of sepsis or features of malignancy. After excluding infective etiologies with serological and cerebrospinal fluid testing, sulfasalazine-induced aseptic meningitis (SIAM) was diagnosed. The patient was then commenced on intravenous steroids, resulting in immediate defervescence and symptom resolution. CONCLUSIONS SIAM remains a diagnostic challenge since patients present with non-specific signs and symptoms, such as pyrexia, headaches, and lassitude. These patients require a thorough investigative battery starting with anamnesis, physical examination, biochemical testing, and radiologic imaging. This case illustrates the need for a high suspicion index of drug-induced hypersensitivity reaction in a rheumatological patient with pyrexial illness where infective etiologies have been confidently excluded. Prompt initiation of intravenous steroids in SIAM provides a dramatic recovery and resolution of symptoms.
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Affiliation(s)
- Tristen Tze Wei Ng
- Department of General Medicine, Joondalup Health Campus, Joondalup, Western Australia, Australia
- Department of Internal Medicine, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Sue Davel
- Department of General Medicine, Joondalup Health Campus, Joondalup, Western Australia, Australia
| | - Kevin David O’Connor
- Stroke Unit, Joondalup Health Campus, Joondalup, Western Australia, Australia
- Department of Immunology, Royal Perth Hospital, Perth, Western Australia, Australia
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5
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Fan Z, He Y, Sun W, Li Z, Ye C, Wang C. Amoxicillin-induced aseptic meningitis: clinical features, diagnosis and management. Eur J Med Res 2023; 28:301. [PMID: 37635233 PMCID: PMC10464253 DOI: 10.1186/s40001-023-01251-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 07/29/2023] [Indexed: 08/29/2023] Open
Abstract
OBJECTIVES The clinical features of aseptic meningitis associated with amoxicillin are unknown. The main objective of this study was to investigate the clinical characteristics of amoxicillin-induced aseptic meningitis (AIAM) and provide a reference for clinical diagnosis and treatment. METHODS AIAM-related studies were collected by searching the relevant databases from inception to October 31, 2022. RESULTS AIAM usually occurred 3 h to 7 days after amoxicillin administration in 13 males and 9 females. Twenty-one patients (95.5%) had recurrent AIAM with a total of 62 episodes. Fever (19 cases, 86.4%) and headache (18 cases, 81.8%) were the most common symptoms. Typical cerebrospinal fluid (CSF) findings were leukocytosis (100%) with lymphocytic predominance (14 cases, 63.6%), elevated protein (20 cases, 90.1%), normal glucose (21 cases, 95.5%) and negative culture (21 cases, 100%). Brain magnetic resonance imaging showed mild meningeal enhancement in one patient. The symptoms resolved mainly within 1-4 days after drug discontinuation in all patients. CONCLUSION Clinical attention should be given to the adverse effects of AIAM. The medication history of patients with suspected meningitis should be investigated to avoid unnecessary examination and antibiotic treatment.
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Affiliation(s)
- Zhiqiang Fan
- Department of Pharmacy, The First Hospital of Hunan University of Chinese Medicine, Changsha, 410007, Hunan, China
- College of Pharmacy, Changsha Medical University, Changsha, 410219, Hunan, China
| | - Yang He
- Department of Pharmacy, The First Hospital of Hunan University of Chinese Medicine, Changsha, 410007, Hunan, China
- College of Pharmacy, Changsha Medical University, Changsha, 410219, Hunan, China
| | - Wei Sun
- Department of Pharmacy, The Third Xiangya Hospital, Central South University, No. 138 Tongzipo Road, YueLu District, Changsha, 410013, Hunan, China
| | - Zuojun Li
- Department of Pharmacy, The Third Xiangya Hospital, Central South University, No. 138 Tongzipo Road, YueLu District, Changsha, 410013, Hunan, China
| | - Chao Ye
- Department of Pharmacy, The Third Hospital of Changsha, Changsha, 410015, Hunan, China.
| | - Chunjiang Wang
- College of Pharmacy, Changsha Medical University, Changsha, 410219, Hunan, China.
- Department of Pharmacy, The Third Xiangya Hospital, Central South University, No. 138 Tongzipo Road, YueLu District, Changsha, 410013, Hunan, China.
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6
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Pata G, Montagna M, Bosi E, Davalli A, Rovere Querini P. Trimethoprim-sulfamethoxazole induced aseptic meningitis case report. Medicine (Baltimore) 2023; 102:e32475. [PMID: 36607874 PMCID: PMC9829252 DOI: 10.1097/md.0000000000032475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
RATIONALE Drug-induced aseptic meningitis (DIAM) is an uncommon meningitis and trimethoprim with or without sulfamethoxazole is the most involved antibiotic. Although DIAM is easily treated with the discontinuation of the causative drug, the diagnosis is a big challenge for physicians, as it remains a diagnosis of exclusion. Here, we present a case report of trimethoprim-sulfamethoxazole induced aseptic meningitis in a woman with acute osteomyelitis. PATIENT CONCERNS A 52-year-old woman was admitted to the hospital for septic shock and acute osteomyelitis of the right homerus. She was started on antibiotic therapy with oxacillin and daptomycin, then oxacillin was replaced with cotrimoxazole, due to its excellent tissue penetration, including bone tissue. During cotrimoxazole therapy, the patient developed a fluent aphasia with ideomotor apraxia and muscle hypertonus. DIAGNOSIS AND INTERVENTIONS Having excluded infectious, epileptic and vascular causes of the acute neurologic syndrome of our patient, given the improvement and full recovery after discontinuation of cotrimoxazole, we hypothesized a DIAM. OUTCOMES After discontinuation of cotrimoxazole, in 48 hours the patient had a full recovery. LESSONS Although DIAM can be easily managed with the withdrawal of the causative drug, it can be difficult to recognize if it is not included in the differential diagnosis. An antimicrobial stewardship program with a strict monitoring of patients by infectious disease specialists is essential, not only to optimize the appropriate use of antimicrobials, but also to improve patient outcomes and reduce the likelihood of adverse events.
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Affiliation(s)
- Giulia Pata
- Vita-Salute San Raffaele University, Milan, Italy
| | | | - Emanuele Bosi
- Vita-Salute San Raffaele University, Milan, Italy
- Diabetes and Endocrinology Unit, Department of Internal Medicine, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Davalli
- Diabetes and Endocrinology Unit, Department of Internal Medicine, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Patrizia Rovere Querini
- Vita-Salute San Raffaele University, Milan, Italy
- Diabetes and Endocrinology Unit, Department of Internal Medicine, IRCCS San Raffaele Scientific Institute, Milan, Italy
- * Correspondence: Patrizia Rovere Querini, Vita-Salute San Raffaele University, Milan 20132, Italy (e-mail: )
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7
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Vickery SB, Roach JK, Parsons C, Vickery PB. Possible levetiracetam-induced aseptic meningitis versus viral meningitis: Case report and literature review. Nurse Pract 2022; 47:32-37. [PMID: 35758918 DOI: 10.1097/01.npr.0000843216.79693.7e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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8
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Affiliation(s)
- J Finsterer
- Neurology & Neurophysiology Center, Vienna, Austria.
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9
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Arakawa A, Iizuka M, Matsuda S, Matsubara E, Yamazaki H, Yoshikawa N, Tanaka H, Yoshizawa T. Aseptic Meningitis-retention Syndrome Associated with Tocilizumab in a Patient with Idiopathic Multicentric Castleman Disease. Intern Med 2021; 60:3995-3998. [PMID: 34219105 PMCID: PMC8758442 DOI: 10.2169/internalmedicine.6938-20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
This is the first report of tocilizumab-associated meningitis-retention syndrome in a patient with idiopathic multicentric Castleman disease. A 57-year-old man presented with headache, nuchal rigidity, impaired consciousness, pyramidal tract signs and urinary retention. A cerebrospinal fluid examination revealed increased cell counts and protein levels. These symptoms were improved by intravenous methylprednisolone. Tocilizumab-associated meningoencephalitis has been reported in patients with rheumatoid arthritis and juvenile idiopathic arthritis but not with multicentric Castleman disease. This case presents evidence of the increased probability of meningitis as a neurological complication of tocilizumab administration.
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Affiliation(s)
- Akira Arakawa
- Department of Neurology, NTT Medical Center Tokyo, Japan
| | - Masaki Iizuka
- Department of Neurology, NTT Medical Center Tokyo, Japan
| | | | - Erika Matsubara
- Department of Rheumatology and Allergy, IMSUT Hospital, The Institute of Medical Science, The University of Tokyo, Japan
| | - Hiroki Yamazaki
- Department of Rheumatology and Allergy, IMSUT Hospital, The Institute of Medical Science, The University of Tokyo, Japan
| | - Noritada Yoshikawa
- Department of Rheumatology and Allergy, IMSUT Hospital, The Institute of Medical Science, The University of Tokyo, Japan
| | - Hirotoshi Tanaka
- Department of Rheumatology and Allergy, IMSUT Hospital, The Institute of Medical Science, The University of Tokyo, Japan
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10
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Affiliation(s)
- Lisa Mäder
- From the Department of Neurology and Neurointensive Care Medicine, Klinikum Darmstadt, Darmstadt
| | - Rainer Kollmar
- From the Department of Neurology and Neurointensive Care Medicine, Klinikum Darmstadt, Darmstadt
| | - Hanns-Martin Lorenz
- Division of Rheumatology, Department of Medicine V, Universitätsklinikum Heidelberg, Heidelberg, Germany
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11
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Katakura Y, Kimura T, Kusano T, Tatsumi F, Iwamoto Y, Sanada J, Fushimi Y, Shimoda M, Kohara K, Nakanishi S, Kaku K, Mune T, Kaneto H. Case Report: A Variety of Immune-Related Adverse Events Triggered by Immune Checkpoint Inhibitors in a Subject With Malignant Melanoma: Destructive Thyroiditis, Aseptic Meningitis and Isolated ACTH Deficiency. Front Endocrinol (Lausanne) 2021; 12:722586. [PMID: 34712202 PMCID: PMC8547604 DOI: 10.3389/fendo.2021.722586] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 09/20/2021] [Indexed: 11/16/2022] Open
Abstract
Recently, immune checkpoint inhibitors have been drawing much attention as cancer immunotherapy, but it has been shown that various immune-related adverse events (irAEs) are induced by immune checkpoint inhibitors in various organs, which has become one of the serious issues at present. A 58-year-old Japanese male with malignant melanoma was treated with nivolumab and/or ipilimumab. During the period of treatment, he suffered from various irAEs. Firstly, about 1 month after starting nivolumab monotherapy, destructive thyroiditis was induced, and so we started replacement therapy with levothyroxine. Secondly, about 1 month after starting nivolumab and ipilimumab combination therapy, aseptic meningitis was induced. We stopped both drugs and started steroid therapy with prednisolone. Finally, about 9 months after restarting nivolumab, isolated adrenocorticotropic hormone (ACTH) deficiency was induced, and so we started replacement therapy with hydrocortisone. Taken together, we should bear in mind the possibility of a variety of irAEs when we use immune checkpoint inhibitors.
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Affiliation(s)
| | - Tomohiko Kimura
- Department of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School, Kurashiki, Japan
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12
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Abstract
BACKGROUND Drug-induced aseptic meningitis is a rare, but challenging diagnosis, most commonly reported with nonsteoroidal anti-inflammatory drugs (NSAIDs) and antibiotics. Trimethoprim/sulfamethoxazole (TMP/SMX) is a sulfonamide that is widely used in clinical practice for the treatment and prophylaxis of various infections. The most common side effects associated with TMP/SMX are generally mild and self-limited, but serious side effects have been reported, including liver injury and aseptic meningitis. CASE PRESENTATION We report a 2,5 year old Dutch girl with both drug-induced aseptic meningitis and drug-induced liver injury while using TMP/SMX prophylaxis. Ursodeoxycholic acid was started because of cholestatic injury. After cessation of TMP/SMX, full convalescence was reached within weeks. CONCLUSIONS This is the first report of a young patient with both aseptic meningitis and drug-induced liver injury caused by TMP/SMX. Drug-induced aseptic meningitis and cholestatic hepatitis constitute a considerable diagnostic challenge to clinicians. In addition to a thorough evaluation for infectious causes, clinicians should be aware of drug-induced aseptic meningitis and cholestatic hepatitis.
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Affiliation(s)
- J A A van Asperdt
- Department of Paediatrics, Elisabeth-Tweesteden Hospital, Hilvarenbeekseweek 60, 5022 GC, Tilburg, The Netherlands.
| | - R A De Moor
- Department of Paediatrics, Elisabeth-Tweesteden Hospital, Hilvarenbeekseweek 60, 5022 GC, Tilburg, The Netherlands
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13
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Wesley SF, Haggiagi A, Thakur KT, De Jager PL. Neurological Immunotoxicity from Cancer Treatment. Int J Mol Sci 2021; 22:6716. [PMID: 34201529 PMCID: PMC8268562 DOI: 10.3390/ijms22136716] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 06/09/2021] [Accepted: 06/09/2021] [Indexed: 12/24/2022] Open
Abstract
The emergence of immune-based treatments for cancer has led to a growing field dedicated to understanding and managing iatrogenic immunotoxicities that arise from these agents. Immune-related adverse events (irAEs) can develop as isolated events or as toxicities affecting multiple body systems. In particular, this review details the neurological irAEs from immune checkpoint inhibitors (ICI) and chimeric antigen receptor (CAR) T cell immunotherapies. The recognition and treatment of neurological irAEs has variable success, depending on the severity and nature of the neurological involvement. Understanding the involved mechanisms, predicting those at higher risk for irAEs, and establishing safety parameters for resuming cancer immunotherapies after irAEs are all important fields of ongoing research.
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Affiliation(s)
- Sarah F. Wesley
- Multiple Sclerosis Center, Department of Neurology, Division of Neuroimmunology, Columbia University Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center-New York Presbyterian Hospital, 710 W 168th Street, Neurological Institute, New York, NY 10032, USA;
| | - Aya Haggiagi
- Department of Neurology, Division of Neuro-Oncology, Columbia University Vagelos College of Physicians and Surgeons, Herbert Irving Comprehensive Cancer Center, New York-Presbyterian Hospital, New York, NY 10032, USA;
| | - Kiran T. Thakur
- Program in Neuroinfectious Diseases and Related Disorders, Division of Critical Care and Hospitalist Neurology, Columbia University Irving Medical Center-New York Presbyterian Hospital, New York, NY 10032, USA;
| | - Philip L. De Jager
- Multiple Sclerosis Center, Department of Neurology, Division of Neuroimmunology, Columbia University Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center-New York Presbyterian Hospital, 710 W 168th Street, Neurological Institute, New York, NY 10032, USA;
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14
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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. Hawaii J Health Soc Welf 2021; 80:129-133. [PMID: 34195619 PMCID: PMC8237324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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15
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Abstract
Mumps is a vaccine-preventable disease. Because the mumps vaccine can cause aseptic meningitis in rare cases, this vaccine is not routine in Japan. This has led to low vaccine coverage and severe disease burden in Japan. The present review summarizes mumps epidemiology and vaccination and discusses effective future strategies to mitigate the current disease burden of mumps in Japan. Although a recent study reported that mumps vaccine coverage rates are improving in Japan, current coverage rates are far below the optimal rate to suppress the ongoing epidemic, which has caused an average annual financial loss of 85 billion JPY between 2000 and 2016. Recent reports have demonstrated a much lower incidence of vaccine-induced aseptic meningitis in newly developed vaccines, especially when administered at 1 year of age. Cost-effectiveness studies suggest that routinization of the currently distributed domestic vaccine would be highly cost-effective. In addition, questionnaire surveillance data suggest that the majority of the Japanese population accepts the nominal risk of the vaccine when the proper information is provided. Finally, there are some successful programs in Japan that have attained high vaccine coverage rates with financial support from local governments. Taken together, these data suggest that the mumps vaccine should be immediately included in routine vaccines in Japan.
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Affiliation(s)
- Taito Kitano
- Division of Infectious Diseases, The Hospital for Sick Children, Toronto, ON, Canada
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16
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Akça ÜK, Sökmen O, Bölek EÇ, Demir S, Kılıç L, Çevik IÜ, Bilginer Y. A case report of intracranial hypertension and aseptic meningitis: anti-tumor necrosis factor associated or juvenile idiopathic arthritis related. Turk J Pediatr 2021; 63:522-526. [PMID: 34254500 DOI: 10.24953/turkjped.2021.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND The adverse effects of tumor necrosis factor alpha inhibitors (TNFi) are well characterized but rare adverse events are increasing day by day. CASE We presented an 18-year-old girl with rheumatoid factor positive polyarticular juvenile idiopathic arthritis (JIA) who developed fever, headache, and nausea after the second dose of adalimumab. In addition to her suspicious complaints for meningitis, she had bilateral papilledema and partial abducens nerve palsy. Leptomeningeal contrast enhancement was noted in magnetic resonance imaging (MRI) of the brain. Brain MRI venography was normal. The cerebrospinal fluid (CSF) opening pressure was high but CSF analysis was normal. She was diagnosed with non-infectious subacute meningitis. Since brain biopsy was not performed, no definite distinction could be made between TNFi related aseptic meningitis or cerebral involvement of JIA. Due to the onset of neurological complaints after initiation of adalimumab treatment and rare cerebral involvement in JIA, the drug-associated aseptic meningitis was likely to be responsible in our patient. Adalimumab was discontinued and methylprednisolone followed by methotrexate treatment were initiated. Her symptoms resolved and control brain MRI was normal. CONCLUSION Pediatric rheumatologists should be aware of this potentially severe side effect of anti-TNF treatment.
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Affiliation(s)
- Ümmüşen Kaya Akça
- Division of Pediatric Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Okan Sökmen
- Departments of Neurology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ertuğrul Çağrı Bölek
- Departments of Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Selcan Demir
- Division of Pediatric Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Levent Kılıç
- Departments of Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Işın Ünal Çevik
- Departments of Neurology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Yelda Bilginer
- Division of Pediatric Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Arian M, AkbariRad M, Moghaddam AB, Firoozi A, Jami M. Allopurinol and Loss of Consciousness in a 78-old Year Man Suffering from Gout. Infect Disord Drug Targets 2020; 20:253-256. [PMID: 30686265 DOI: 10.2174/1871526519666190128102039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 12/15/2018] [Accepted: 01/17/2019] [Indexed: 06/09/2023]
Abstract
Allopurinol is an FDA -Approved xanthine oxidase inhibitor, which is effective in the treatment of gout, hyperuricemia and uremic kidney stones in patients with an increased level of uric acid excretion. Xanthine oxidase acts by converting hypoxanthine and xanthine into uric acid, and therefore its inhibition results in decreased production of uric acid. The most common side effects of this medication are as follows: maculopapular rashes, hives, itching, headache, dizziness, abnormal hair loss, fever and hypersensitivity reaction. Case Presentation: This report represents a case of drug-induced meningitis of a senile man who ended up in the ICU due to the remarkably reduced state of consciousness.
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Affiliation(s)
- Mahnaz Arian
- Department of Infectious Diseases, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mina AkbariRad
- Department of Internal Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ahmad Bagheri Moghaddam
- Department of Anesthesia, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Abdollah Firoozi
- Department of Pharmaceutical Science, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad Jami
- Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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Bello-Chavolla OY, Cortes-Arroyo JE, Vargas-Vazquez A, Quiroz-Compean F, Leal-Gutierrez G, Barragan-Dessavre M, Martinez-Samano JE. [Meningeal syndrome in a patient treated with a combination of immune checkpoint inhibitors for a metastatic melanoma]. Rev Neurol 2018; 67:279-280. [PMID: 30232801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
| | | | - A Vargas-Vazquez
- Universidad Nacional Autonoma de Mexico, 04510 Mexico DF, Mexico
| | - F Quiroz-Compean
- Universidad Nacional Autonoma de Mexico, 04510 Mexico DF, Mexico
| | - G Leal-Gutierrez
- Universidad Nacional Autonoma de Mexico, 04510 Mexico DF, Mexico
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Patel A, Potu KC, Sturm T. A Case of IVIG-Induced Aseptic Chemical Meningitis. S D Med 2017; 70:119-121. [PMID: 28813773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Intravenous immunoglobulin (IVIG) is a commonly used and generally well-tolerated medication. Common side effects include flu-like symptoms such as fevers, headaches, myalgia, fatigue, and nausea. One of the more rare side effects is aseptic meningitis, with a reported incidence rate of around 0.067 percent of all IVIG infusions. In this paper, we describe a 47-year-old female patient with a history of myasthenia gravis who presented with a headache, neck pain, and neck stiffness while undergoing IVIG infusions for a myasthenia crisis. On admission day, the patient was afebrile with stable vital signs. A physical examination revealed nuchal rigidity and tenderness with no focal neurological deficits. Cerebrospinal fluid (CSF) cytology noted an elevated white blood cell (WBC) count of 1,138 cells/μL with a neutrophil predominance (96 percent). CSF red blood cell count was unremarkable at 1 cell/μL. The patient's IVIG infusions were stopped, suspecting chemical meningitis. Given the markedly elevated CSF WBC count with neutrophil predominance, she was started on vancomycin and ceftriaxone to also cover for bacterial meningitis. The patient's meningeal signs and symptoms significantly improved 24 hours after admission. Given the clear temporal relationship to IVIG administration and the rapid improvement of symptoms, IVIG-induced aseptic meningitis is strongly suspected. The patient's antibiotics were discontinued. Forty-eight hours after stopping IVIG and 24 hours after discontinuing antibiotics, her meningitis symptoms completely resolved with the use of analgesics alone. The patient was then discharged uneventfully. CSF viral and bacterial studies, including a gram stain and cultures, did not result in anything noteworthy. Our case presents an interesting diagnostic dilemma where drug-induced (IVIG) aseptic meningitis mimics bacterial meningitis clinically and on CSF analysis. The clear temporal relationship to IVIG administration and the rapid resolution of symptoms upon stopping the drug can aid in the diagnosis of this rare event and help doctors avoid the use of unnecessary antibiotic therapy.
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Affiliation(s)
- Anish Patel
- Department of Internal Medicine, University of South Dakota Sanford School of Medicine
| | | | - Tamera Sturm
- Department of Internal Medicine, University of South Dakota Sanford School of Medicine
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Abdelrahman RZ, Morsy ATA, Morsy TA. ASEPTIC MENINGITIS IN ADULTS CAUSING BY VIRUS, BACTERIA, DRUG WITH SPECIAL REFERENCES TO ZOONOTIC PARASITES. J Egypt Soc Parasitol 2016; 46:319-340. [PMID: 30152941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Diagnosis of a patient with aseptic meningitis may be so-difficult because of the large vanety of potential etiologic agents as viruses, fungi, parasites and some drugs and the overlap between self-limited viral illnesses and potentially fatal bact~nial infections.
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Puy-Nunez A, Dacosta-Balboa M, Cabo-Lopez I, Canneti B, Lopez-Ferreiro A, Rodriguez-Alvarez JR, Rodriguez-Regal A, Mourino-Sestelo MA. [Aseptic meningitis as a complication of immunoglobulin treatment in myasthenia gravis]. Rev Neurol 2016; 62:478-479. [PMID: 27149191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- A Puy-Nunez
- Complejo Hospitalario de Pontevedra, 36001 Pontevedra, Espana
| | | | - I Cabo-Lopez
- Complejo Hospitalario de Pontevedra, 36001 Pontevedra, Espana
| | - B Canneti
- Complejo Hospitalario de Pontevedra, 36001 Pontevedra, Espana
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Ogawa T, Tagawa A, Hashimoto R, Kato H. [A case of recurrent aseptic meningitis induced by ergot agents]. Rinsho Shinkeigaku 2015; 55:421-423. [PMID: 26103816 DOI: 10.5692/clinicalneurol.cn-000643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
We describe the case of a 29-year-old woman with recurrent aseptic meningitis that was caused by ergot agents. She miscarried at age 27, and the uterus constrictor methylergometrine was prescribed. Three days later, she developed aseptic meningitis and was hospitalized. Two years later, she again developed aseptic meningitis the day after she took ergotamine tartrate. In both events, her symptoms improved rapidly when the medication was stopped. The drug-induced lymphocyte stimulation test for methylergometrine yielded a value of 180%. Drug-induced meningitis is a rare form of recurrent aseptic meningitis. Many studies have reported cases of meningitis caused by non-steroidal anti-inflammatory drugs, but many other drugs can induce aseptic meningitis. To the best of our knowledge, this is the first case of aseptic meningitis induced by ergot agents.
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Affiliation(s)
- Tomoko Ogawa
- Department of Neurology, International University of Health and Welfare Hospital
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23
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Lockwood JR, Carr D. Drug-induced aseptic meningitis secondary to trimethoprim/sulfamethoxazole: a headache to be aware of. CAN J EMERG MED 2014; 16:421-424. [PMID: 25227653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Trimethoprim/sulfamethoxazole (TMP/SMX), also known as Septra, is a commonly encountered and prescribed antibiotic in emergency department patients. The side effects associated with TMP/SMX are generally mild and self-limited, but serious side effects, including Stevens-Johnson syndrome and drug-induced aseptic meningitis, have been reported. We discuss the case of a 33-year-old woman who presented to our emergency department with the signs and symptoms of meningeal inflammation after being prescribed TMP/SMX 3 days earlier for an abscess with cellulitis.
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Salouage I, El Aïdli S, Cherif F, Kastalli S, Zaiem A, Daghfous R. Sulfasalazine-induced aseptic meningitis with positive rechallenge: a case report and review of the literature. Therapie 2013; 68:423-6. [PMID: 24356191 DOI: 10.2515/therapie/2013065] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Accepted: 09/19/2013] [Indexed: 11/20/2022]
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Abstract
Iatrogenic meningitis can be caused by a number of mechanisms. The recent case reports of fungal meningitis after application of epidural methylprednisolone caused warning in the medical community. Cases were caused by contaminated lots of methylprednisolone from a single compounding pharmacy. Several medications can cause meningitis by probable hypersensitivity mechanism. Neurologists should be alert to the recent description of the use of lamotrigine and development of aseptic meningitis.
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Sethi NK. Lamotrigine and aseptic meningitis. Neurology 2012; 79:833-834. [PMID: 23082320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
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28
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Numasawa Y, Mizusawa H. [Neuromuscular side effects]. Nihon Rinsho 2012; 70 Suppl 6:111-116. [PMID: 23156495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Yoshiyuki Numasawa
- Department of Neurology and Neurological Science, Graduate School, Tokyo Medical and Dental University
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29
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Shimazaki H, Nakano I. [Drug-induced aseptic meningitis]. Nihon Rinsho 2012; 70 Suppl 6:666-670. [PMID: 23156594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Haruo Shimazaki
- Division of Neurology, Department of Internal Medicine, Jichi Medical University
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Mullane D, Williams L, Merwick A, Tobin WO, McGuigan C. Drug induced aseptic meningitis caused by intravenous immunoglobulin therapy. Ir Med J 2012; 105:182-183. [PMID: 22973657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Drug induced aseptic meningitis (DIAM) is an uncommon condition that can mimic infective conditions. DIAM has been recognized with various treatments including non-steroidal anti-inflammatory drugs, monoclonal antibodies and some antibiotics. We report a patient presenting with aseptic meningitis forty-eight hours after commencing a course of intravenous immunoglobulin (IVIG) treatment. It is important that physicians prescribing this medication are aware of this rare complication so the diagnosis can be made quickly and the patient is not exposed to unnecessary treatments.
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Affiliation(s)
- D Mullane
- Department of Neurology, St Vincent's University Hospital, Elm Park, Dublin 4
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Galindo Bonilla PA, Sánchez Rodríguez N, Castro Jiménez A, Muñoz-Torrero Rodríguez JJ, Bellón Heredia T, Feo Brito F. Aseptic meningitis induced by vitamin B complex. J Investig Allergol Clin Immunol 2012; 22:225-226. [PMID: 22697018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
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García Norniella B, Morán Poladura M, Fernández Díaz M, Fernández Fernández E, Suárez Castañón C. [Aseptic meningitis secondary to intravenous immunoglobulin treatment in Kawasaki disease]. An Pediatr (Barc) 2011; 75:79-80. [PMID: 21420919 DOI: 10.1016/j.anpedi.2010.11.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2010] [Revised: 11/05/2010] [Accepted: 11/08/2010] [Indexed: 11/19/2022] Open
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Abstract
INTRODUCTION The mechanisms underlying early central nervous system (CNS) signs and symptoms of glyphosate-surfactant herbicide (GlySH) poisoning are unclear. CASE PRESENTATION A 58-year-old woman ingested approximately 150 mL of GlySH containing 41% glyphosate and 15% polyoxyethyleneamine. Two days later, she was admitted in the Emergency Center in a semicomatose state. Acute respiratory distress syndrome, circulatory collapse, acute renal failure, and disseminated intravascular coagulopathy were diagnosed. Meningitis was also suspected as she demonstrated Kernig's sign and significant neck stiffness with rigidity of the extremities as well as consciousness disturbance and fever (38.4°C). Investigations of cerebrospinal fluid (CSF) revealed the presence of glyphosate (122.5 μg/mL), significant elevation of IL-6 (394 μg/mL), and pleocytosis (32 cells/μL) with monocyte dominance. All bacteriological and virological tests were later found to be negative. She recovered completely after responding to aggressive supportive care in the intensive care unit. All signs and symptoms suggesting meningitis resolved as the concentration of glyphosate in CSF decreased. She was discharged on day 39 of hospitalization. DISCUSSION These findings suggest that the present case involved aseptic meningitis in association with GlySH poisoning. CONCLUSION CNS signs and symptoms induced by aseptic meningitis should be considered in cases of glyphosate-surfactant herbicide poisoning.
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Affiliation(s)
- Chie Sato
- Department of Emergency and Critical Care Medicine, School of Medicine, Kitasato University, Minamiku, Sagamihara, 252-0374, Japan.
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Moreno-Ancillo A, Gil-Adrados AC, Jurado-Palomo J. Ibuprofen-induced aseptic meningoencephalitis confirmed by drug challenge. J Investig Allergol Clin Immunol 2011; 21:484-487. [PMID: 21995183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
Drug-induced aseptic meningitis (DIAM) is a diagnostic challenge. The major causative agents are nonsteroidal anti-inflammatory drugs (particularly ibuprofen), antibiotics, intravenous immunoglobulin, and OKT3 monoclonal antibodies. DIAM is more frequently observed in patients with autoimmune diseases. A 36-year-old woman was attended in our department 3 months after being diagnosed with aseptic meningoencephalitis. She had had 2 episodes in 9 months. Neurological symptoms were associated with ibuprofen. A challenge with acetylsalicylic acid was negative, whereas a drug challenge with ibuprofen was positive. Thirty minutes after ingesting 50 mg of ibuprofen, she experienced general malaise and progressively developed chills, fever (39.5 degrees C), headache, and nuchal rigidity. Lumbar puncture showed normal glucose and high protein levels. Neutrophilic pleocytosis was observed at the first admission; lymphocytosis was predominant in the second and third episodes. DIAM is a rare and severe hypersensitivity reaction. Drug challenge enabled us to make an accurate diagnosis.
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Affiliation(s)
- A Moreno-Ancillo
- Department of Allergy, Hospital Nuestra Señora del Prado, Talavera de la Reina, Spain.
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Sepcić J, Bucuk M, Perković O, Sepić-Grahovac D, Troselj-Vukić B, Poljak I, Crnić-Martinović M, Turel I, Ristić S, Sepcić K. Drug-induced aseptic meningitis, sensorineural hearing loss and vestibulopaty. Coll Antropol 2010; 34:1101-1104. [PMID: 20977110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
We report clinically rare and serious adverse reactions that occurred after the co-administration of ranitidine, ibuprofen and ciprofloxacin: completely reversible aseptic meningitis and irreversible bilateral sensorineural hearing loss, tinnitus, and vestibulopathy. Recurrent urinary inflammations treated with antibacterials, classic familial migraine, and allergy to trimethoprim-sulfamethoxazole and chromium were favourable predisposing factors for the adverse event in this patient. A close chronological relation between administration of drugs (especially ibuprofen) and adverse reactions was noted. No evidence of infection and/or autoimmune disease was found. The mechanism of these serious events may be explained as a hypersensitive reaction affecting the meninges and, partially, cochlea.
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Affiliation(s)
- Juraj Sepcić
- School of Medicine, Rijeka University, Rijeka, Croatia
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Pituch-Noworolska A, Błaut-Szlósarczyk A, Zwonarz K. [The use of human immunoglobulins--adverse reactions]. Pol Merkur Lekarski 2010; 29:202-205. [PMID: 20931833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The primary immunodeficiency, mainly humoral immunity, secondary immunodeficiency and autoimmune diseases are the indications for immunoglobulins substitution. The prolonged substitution in primary immunodeficiency includes regular intravenous infusion of immunoglobulins in 0.4-0.6 g/kg of body weight every 21-28 days. The purpose of such substitution is decrease of frequency and diminishes the clinical course of infections. The high-dose use of immunoglobulins (1-2 g/kg body weight) is preferred in autoimmune diseases based on suppressive and anti-inflammatory activity of immunoglobulins. The subcutaneous administration of immunoglobulins is an alternative to intravenous way, but the singular dose (0.1 g/kg body weight) is too low for suppressive and anti-inflammatory activity of immunoglobulins, so this substitution is indicated in primary immunodeficiency only. The adverse events of immunoglobulins differentiate because of time of occurrence and clinical character. The rapid symptoms occurred just after beginning of infusion and often present the clinical features of anaphylactoid reaction. During the infusion the occurring adverse symptoms are mild and the life-threatening situations are very rare. The next periods of typical adverse reaction are 24-48 hrs after infusion, 72 hrs and later. The mechanisms leading to adverse reaction to immunoglobulins are based on presence of IgG dimmers, stimulating high production of pro-inflammatory cytokines by immunocompetent cells. High level of cytokines is associated with high fever, chills, flu-like symptoms, feeling malaise and sick. The reaction of anti-IgA antibodies present in patient serum with IgA in immunoglobulins preparation is responsible for moderate and severe adverse clinical symptoms. The late adverse events present the symptoms of aseptic meningo-encephalitis. In case of adverse events the stopping of infusion, additions saline/ glucose infusion, anti-histaminic drugs of I and II generation and steroids are used. Severe adverse events are indication for withdraw the immunoglobulins intravenous infusions. In these patients the subcutaneous way of immunoglobulins substitution is an alternative with hope that low singular dose and slow uptake may be better tolerated.
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Affiliation(s)
- Anna Pituch-Noworolska
- Uniwersytet Jagielloński w Krakowie, Collegium Medicum, Zakład Immunologii Klinicznej, Polsko-Amerykański Instytut Pediatrii.
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Lundberg A, Hallberg P. [Meningitis--a very rare adverse effect of lamotrigine treatment]. Lakartidningen 2010; 107:1861-1862. [PMID: 20873340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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40
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Asano T, Koizumi S, Mishina-Ikegami K, Hatori T, Miyasho T, Fujino O. Increased levels of Monocyte Chemoattractant Protein-1 in cerebrospinal fluid with gamma globulin induced meningitis. Acta Paediatr 2010; 99:164-5. [PMID: 19832741 DOI: 10.1111/j.1651-2227.2009.01550.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Farr KP, Mogensen CB. [Drug-induced aseptic meningitis]. Ugeskr Laeger 2010; 172:298-299. [PMID: 20105400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Drug-induced aseptic meningitis is a rare adverse effect of some drugs. We report a patient with four episodes of meningitis caused by ibuprofen. In all episodes the patient had taken ibuprofen for pain, and subsequently developed fever and cerebrovascular symptoms. Drug-induced meningitis cannot be distinguished from meningitis caused by other agents. Diagnosis is therefore based on close association between drug administration and onset of symptoms, as well as negative microbiology tests results, especially if previous episodes of drug-induced meningitis have occurred.
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Abstract
OBJECTIVE To investigate the relationship between aseptic meningitis and anti-U1RNP antibody in patients diagnosed with CTD. METHODS Fourteen patients with aseptic meningitis were selected from among patients with CTDs who had visited our hospital. We analyzed their medical records to clarify the clinical and immunological features of aseptic meningitis. RESULTS A total of 14 patients with aseptic meningitis were subsequently diagnosed as having either SLE (seven cases), MCTD (four), UCTD (one), overlap syndrome (one), or Sjögren's syndrome (one). Eight of the 14 patients had received NSAIDs, such as sulindac, naproxen, or loxoprofen, before the onset of aseptic meningitis. CRP levels were increased (mean +/- SD: 7.1 +/- 7.1 mg/dL) and CRP levels (10.4 +/- 7.7) in the drug-induced group were significantly increased (p < 0.01). The anti-U1RNP antibody was found in 13 of the 14 patients. There were no significant differences in cerebrospinal fluid findings between the drug-induced group and the non-drug-induced group. CONCLUSIONS SLE or MCTD patients with aseptic meningitis tend to have anti-U1RNP antibody.
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Affiliation(s)
- J Okada
- Division of Rheumatology, Department of Internal Medicine, Kitasato University School of Medicine, 1-15-1, Kitasato, Sagamihara, Kanagawa, 228-8555 Japan.
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Pons Garcia MA, Ramirez Moreno JM. [Recurrent ibuprofen-induced aseptic meningitis]. Neurologia 2009; 24:277. [PMID: 19950423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
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Abstract
A 36-year-old male with systemic lupus erythematosus developed aseptic meningitis after ingestion of ibuprofen. He was unconscious, had a universal rash, high fever and a pathological CSF. Being severely ill he was treated with high doses of corticosteroids and plasmapheresis and recovered within a week.
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Abstract
A patient with acute lymphocytic leukemia (ALL) who was treated with high-dose cytosine arabinoside (Ara-C) 3 g/m2 twice daily, developed reversible acute aseptic meningitis and signs of cerebellar dysfunction after a total dose of 24 g Ara-C. To our knowledge this is the first case report of meningitis complicating intravenous high-dose Ara-C therapy.
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Mekonnen D, Bane A. Meningitis complicated with sinus venous thrombosis and intracranial hemorrhage in a patient who received bupivacaine spinal anesthesia. Ethiop Med J 2008; 46:277-280. [PMID: 19271393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
We report a 26 year old male patient who developed meningitis with cerebral venous thrombosis and multiple intracranial hemorrhages following spinal anesthesia. He received 15 mg of bupivacaine at L3-L4 level for diagnostic arthroscopy of a right knee joint at the major operation theatre.
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MESH Headings
- Adult
- Anesthesia, Spinal/adverse effects
- Anesthetics, Local/adverse effects
- Anti-Bacterial Agents/therapeutic use
- Arthroscopy
- Bupivacaine/adverse effects
- Humans
- Intracranial Hemorrhages/complications
- Intracranial Hemorrhages/diagnostic imaging
- Intracranial Hemorrhages/surgery
- Knee Joint/surgery
- Male
- Meningitis, Aseptic/cerebrospinal fluid
- Meningitis, Aseptic/chemically induced
- Meningitis, Aseptic/diagnosis
- Meningitis, Aseptic/drug therapy
- Postoperative Complications/chemically induced
- Sinus Thrombosis, Intracranial/complications
- Sinus Thrombosis, Intracranial/diagnostic imaging
- Sinus Thrombosis, Intracranial/surgery
- Tomography, X-Ray Computed
- Venous Thrombosis/complications
- Venous Thrombosis/diagnostic imaging
- Venous Thrombosis/surgery
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Affiliation(s)
- Desalew Mekonnen
- Department of Internal Medicine, Faculty of Medicine, Addis Ababa University, Addis Ababa
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MESH Headings
- Acquired Immunodeficiency Syndrome/drug therapy
- Adult
- Anticonvulsants/adverse effects
- Blood/microbiology
- Blood Chemical Analysis
- Cerebrospinal Fluid/chemistry
- Cerebrospinal Fluid/microbiology
- Diagnosis, Differential
- Female
- Fever/chemically induced
- Humans
- Lamotrigine
- Male
- Meningitis, Aseptic/chemically induced
- Meningitis, Aseptic/diagnosis
- Meningitis, Aseptic/physiopathology
- Meningitis, Bacterial/blood
- Meningitis, Bacterial/cerebrospinal fluid
- Meningitis, Bacterial/diagnosis
- Meningitis, Viral/blood
- Meningitis, Viral/cerebrospinal fluid
- Meningitis, Viral/diagnosis
- Phenobarbital/adverse effects
- Triazines/adverse effects
- Valproic Acid/adverse effects
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Besocke AG, Santamarina R, Romano LM, Femminini RA. [Bupivacaine induced aseptic meningitis]. Neurologia 2007; 22:551-2. [PMID: 17641986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023] Open
Abstract
INTRODUCTION Drug-induced aseptic meningitis (DIAM) is an uncommon adverse reaction secondary to the administration of numerous agents. It is diagnosed by exclusion, and its outcome is generally excellent with complete long term recovery. There are few reports of DIAM associated to intrathecal administration of bupivacaine in the literature. CASE REPORT We present a 16 year-old male patient who received spinal anaesthesia with 10 mg of bupivacaine prior to orthopedic surgery. A few hours later he complained of headache followed by confusion and stupor. A TC scan of the brain was normal. Diagnostic lumbar puncture revealed cloudy cerebrospinal fluid (CSF) with increased polymorphonuclear, increased protein and decreased glucose concentrations. Immediate treatment with antibiotics and corticosteroids was instituted and the patient rapidly recovered without sequelae. Blood and CSF cultures were negative, antibiotics were suspended and corticosteroids tapered. CONCLUSION To the best of our knowledge, we report a case of bupivacaine induced aseptic meningitis.
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Affiliation(s)
- A G Besocke
- Serviciio de Neurología, Hospital Privado de Comunidad, Mar de Plata (Argentina).
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Abstract
OBJECTIVE To report a case of aseptic meningitis induced by intramuscularly administered methotrexate in a patient with rheumatoid arthritis. CASE SUMMARY A 62-year-old male presented on 3 separate occasions with symptoms consistent with aseptic meningitis: 2 required hospitalization and 1 was noted during a subsequent ambulatory care visit. Prior to the first episode, the methotrexate dose ranged between 17.5 mg and 20 mg given once weekly over 5 years, 11 months. One month before the patient's first admission, the dose was increased to 22.5 mg. Symptoms on presentation included headache, neck stiffness, and fever. Cerebrospinal fluid testing indicated pleocytosis and low glucose level. Methotrexate was discontinued but was restarted 2 weeks after hospital discharge at the same dose and resulted in a second hospitalization for aseptic meningitis. Upon discharge from the second hospitalization, methotrexate was withheld. After a 2 month withdrawal period and rechallenge, the symptoms returned within 3 days. The drug was then discontinued. DISCUSSION Methotrexate-induced aseptic meningitis has been reported in the literature; however, in those cases, the effect occurred only when methotrexate was given via the intrathecal route. We identified 7 relevant articles via a search of MEDLINE, International Pharmaceutical Abstracts, and EMBASE (1970-August 3, 2007): 3 were review articles, 2 were case series, and 2 were case reports. All of the series and reports involved patients with leukemia. The available literature suggests that aseptic meningitis is associated with long-term use of methotrexate or recent dose escalation. A definitive mechanism for methotrexate-induced aseptic meningitis is not known. The Naranjo probability scale indicates a probable relationship between the development of the condition and the methotrexate use in our patient. CONCLUSIONS Aseptic meningitis has been previously associated with intrathecal use of methotrexate. Our report describes the first case of aseptic meningitis that occurred in a patient being treated with intramuscular methotrexate.
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Affiliation(s)
- John Hawboldt
- School of Pharmacy, Health Sciences Centre, Department of Pharmacy, Eastern Health, St. John's, Newfoundland, Canada.
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Callen EC, Church CO, Patel M, Sikes TL. Aseptic meningitis associated with chronic sulindac use for osteoarthritis: a case report. Rheumatol Int 2007; 28:391-3. [PMID: 17703306 DOI: 10.1007/s00296-007-0439-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2007] [Accepted: 07/24/2007] [Indexed: 01/22/2023]
Abstract
We report a case of aseptic meningitis thought to be associated with chronic sulindac use in a patient with osteoarthritis. The patient was hospitalized with an acute onset of headache, nuchal rigidity, nausea, and blurred vision. Brain imaging was unremarkable and a lumbar puncture revealed a lymphocytic pleocytosis. No infectious source was identified. The patient reported taking sulindac over the past year, it was discontinued, and symptoms promptly resolved. This case underscores the importance of obtaining a thorough drug history in conjunction with the knowledge of causative medications associated with aseptic meningitis. Given the widespread use of nonsteroidal anti-inflammatory drugs, clinicians must recognize that aseptic meningitis is a possible adverse effect of these medications.
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Affiliation(s)
- Erin C Callen
- College of Pharmacy, Southwestern Oklahoma State University, Weatherford, OK 73096-3098, USA.
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