Drug induced aseptic meningitis

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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

Clinical Freatures

Symptoms generally occur within 24-48 hours after taking drug

Differential Diagnosis

Headache

Common

Killers

Maimers

Others

Aseptic Meningitis

  • Viral
    • Varicella
    • Herpes
    • Enterovirus
    • West Nile
  • Tuberculosis
  • Lyme disease
  • Syphilis
  • Fungal (AIDS, transplant, chemotherapy, chronic steroid use)
  • Noninfectious
    • Sarcoidosis
    • Vasculitis
    • Connective tissues disease
    • Drug induced aseptic meningitis

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

References