Drug-induced aseptic meningitis - Diagnosis and management

Drug-induced aseptic meningitis (DIAM) has been reported as an uncommon adv erse reaction with numerous agents. It is a diagnosis of exclusion, and cli nical signs and CSF findings vary greatly. The body of evidence regarding D IAM is largely in the form of anecdotal case reports and must be interprete d carefully bearing this in mind. The major categories of causative agents are nonsteroidal anti-inflammatory drugs, antimicrobials, intravenous immunoglobulin, intrathecal agents, vac cines and a number of other less frequently reported agents. There appears to be an association between DIAM and connective tissue disease, particular ly systemic lupus erythematosus, and ibuprofen. There are 2 major proposed mechanisms for DIAM. The first involves direct i rritation of the meninges by intrathecal administration of the drug, and th e second involves immunological hypersensitivity to the drug, most likely t ype III and type IV hypersensitivity. Recognition and diagnosis of DIAM is important, as it is treatable by withd rawal of the drug and recurrence is prevented. The outcome of DIAM is gener ally good, usually without long term sequelae. This article describes the case reports of DIAM in the current literature a nd discusses the diagnosis and management of this rare complication.