Skip to main content
SpringerLink
Log in

Drug-Induced Aseptic Meningitis

Diagnosis and Management

  • Review Article
  • Published:
Drug Safety Aims and scope Submit manuscript

Abstract

Drug-induced aseptic meningitis (DIAM) has been reported as an uncommon adverse reaction with numerous agents. It is a diagnosis of exclusion, and clinical signs and CSF findings vary greatly. The body of evidence regarding DIAM is largely in the form of anecdotal case reports and must be interpreted carefully bearing this in mind.

The major categories of causative agents are nonsteroidal anti-inflammatory drugs, antimicrobials, intravenous immunoglobulin, intrathecal agents, vaccines and a number of other less frequently reported agents. There appears to be an association between DIAM and connective tissue disease, particularly systemic lupus erythematosus, and ibuprofen.

There are 2 major proposed mechanisms for DIAM. The first involves direct irritation of the meninges by intrathecal administration of the drug, and the second involves immunological hypersensitivity to the drug, most likely type III and type IV hypersensitivity.

Recognition and diagnosis of DIAM is important, as it is treatable by withdrawal of the drug and recurrence is prevented. The outcome of DIAM is generally good, usually without long term sequelae.

This article describes the case reports of DIAM in the current literature and discusses the diagnosis and management of this rare complication.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Table I
Table II
Table III

Similar content being viewed by others

References

  1. Marinac JS. Drug- and chemical-induced aseptic meningitis: a review of the literature. Ann Pharmacother 1992; 26: 813–22

    CAS  PubMed  Google Scholar 

  2. Chaudhry HJ, Cunha BA. Drug-induced aseptic meningitis: diagnosis leads to quick resolution. Postgrad Med 1991; 90: 65–70

    CAS  PubMed  Google Scholar 

  3. Crook DW, Phuapradit P,Warrell DA. Bacterial meningitis. In: Weatherall DJ, Ledingham JGG,Warrel DA, editors. Oxford textbook of medicine. 3rd ed. Oxford: Oxford University Press, 1996: 4050–64

    Google Scholar 

  4. Morgan A, Clark D. CNS adverse effects of nonsteroidal antiinflammatory drugs: therapeutic implications. CNS Drugs 1998; 9: 281–90

    CAS  Google Scholar 

  5. Agus B, Nelson J, Kramer N, et al. Acute central nervous system symptoms caused by ibuprofen in connective tissue disease. J Rheumatol 1990; 17 (8): 1094–6

    CAS  PubMed  Google Scholar 

  6. Gilbert GJ, Eichenbaum HW. Ibuprofen-induced meningitis in an elderly patient with systemic lupus erythematosus. South Med J 1989; 82 (4): 514–5

    CAS  PubMed  Google Scholar 

  7. Horn AC, Jarrett SW. Ibuprofen-induced aseptic meningitis in rheumatoid arthritis. Ann Pharmacother 1997; 31 (9): 1009–11

    CAS  PubMed  Google Scholar 

  8. Jensen S, Glud TK, Bacher T, et al. Ibuprofen-induced meningitis in a male with systemic lupus erythematosus. Acta Med Scand 1987; 221 (5): 509–11

    CAS  PubMed  Google Scholar 

  9. Giansiracusa DF, Blumberg S, Kantrowitz FG. Aseptic meningitis associated with ibuprofen [letter]. Arch Intern Med 1980; 140 (11): 1553

    CAS  PubMed  Google Scholar 

  10. Peck MG, Joyner PU. Ibuprofen-associated aseptic meningitis. Clin Pharm 1982; 1 (6): 561–5

    CAS  PubMed  Google Scholar 

  11. Samuelson COJ, Williams HJ. Ibuprofen-associated aseptic meningitis in systemic lupus erythematosus. West J Med 1979; 131 (1): 57–9

    PubMed Central  PubMed  Google Scholar 

  12. Davis BJ, Thompson J, Peimann A, et al. Drug-induced aseptic meningitis caused by two medications. Neurology 1994; 44 (5): 984–5

    CAS  PubMed  Google Scholar 

  13. Grimm AM, Wolf JE. Aseptic meningitis associated with nonprescription ibuprofen use [letter]. DICP 1989; 23 (9): 712

    CAS  PubMed  Google Scholar 

  14. Durback MA, Freeman J, Schumacher VR. Recurrent ibuprofen-induced aseptic meningitis: third episode after only 200mg generic ibuprofen. Arthritis Rheum 1988; 31: 813–5

    CAS  PubMed  Google Scholar 

  15. Lawson JM, Grady MJ. Ibuprofen-induced aseptic meningitis in a previously healthy patient.West J Med 1985; 143: 386–7

    CAS  PubMed Central  PubMed  Google Scholar 

  16. Perera DR, Seiffert AK, Greerly HM. Ibuprofen and meningoencephalitis [letter]. Ann Intern Med 1984; 100 (4): 619

    CAS  PubMed  Google Scholar 

  17. Bernstein RF. Ibuprofen-related meningitis in mixed connective tissue disease. Ann Intern Med 1980; 92: 206–7

    CAS  PubMed  Google Scholar 

  18. Finch WR, StrottmanMP. Acute adverse reactions to ibuprofen in systemic lupus erythematosus. JAMA 1979; 241: 2616–8

    CAS  PubMed  Google Scholar 

  19. Wasner CK. Ibuprofen, meningitis and systemic lupus erythematosus. J Rheumatol 1978; 5: 162–4

    CAS  PubMed  Google Scholar 

  20. Widener HL, Littman BH. Ibuprofen-induced aseptic meningitis in systemic lupus erythematosus. JAMA 1978; 239: 1062–4

    CAS  PubMed  Google Scholar 

  21. Katona BG, Wigley FM, Walters JK, et al. Aseptic meningitis from over-the-counter ibuprofen [letter]. Lancet 1988; I: 59

  22. van der Zwan A, van Dam JG. Ibuprofen meningitis. Ned Tijdschr Geneeskd 1992; 136: 1613–4

    PubMed  Google Scholar 

  23. Kaplan BH, Nevitt MP, Pach JM, et al. Aseptic meningitis and iridocyclitis related to ibuprofen. Am J Ophthalmol 1994; 117: 119–20

    CAS  PubMed  Google Scholar 

  24. Colamarino R, SoubrierM, Zenut-LeaudM, et al. Asepticmeningitis caused by ibuprofen (Nurofen) in connective tissue diseases. Therapie 1993; 48 (5): 516–8

    CAS  PubMed  Google Scholar 

  25. Ewert BH. Ibuprofen-associated meningitis in a woman with only serologic evidence of a rheumatologic disorder. Am J Med Sci 1989; 297: 326–7

    CAS  PubMed  Google Scholar 

  26. Treves R, Gastine H, Richard A, et al. Aseptic meningitis and acute renal failure induced by ibuprofen during the treatment of systemic lupus erythematosus. Rev RheumMal Osteoartic 1983; 50 (1): 75–6

    CAS  Google Scholar 

  27. Bar-Sela S, Levo Y, Zeevi D, et al. A lupus-like syndrome due to ibuprofen sensitivity. J Rheumatol 1980; 7: 379–80

    CAS  PubMed  Google Scholar 

  28. Bouland DL, Specht NL, Hegstad DR. Ibuprofen and aseptic meningitis [letter]. Ann Intern Med 1986; 104 (5): 731

    CAS  PubMed  Google Scholar 

  29. Canoso JJ, Cohen AS. Aseptic meningitis in systemic lupus erythematosus. Arthritis Rheum 1975; 18: 369–74

    CAS  PubMed  Google Scholar 

  30. Mifsud AJ. Drug-related recurrent meningitis. J Infect 1988; 17 (2): 151–3

    CAS  PubMed  Google Scholar 

  31. Chez M, Sila CA, Ransohoff RM, et al. Ibuprofen-induced meningitis: detection of intrathecal IgG synthesis and immune complexes. Neurology 1989; 39: 1578–80

    CAS  PubMed  Google Scholar 

  32. Sonnenblick M, Abraham AS. Ibuprofen hypersensitivity in systemic lupus erythematosus. BMJ 1978; 1: 619–20

    CAS  PubMed  Google Scholar 

  33. Quinn JP, Weinstein RA, Caplan LR. Eosinophilic meningitis and ibuprofen therapy. Neurology 1984; 34: 108–9

    CAS  PubMed  Google Scholar 

  34. Lee RP, King EG, Russell AS. Ibuprofen: a severe systemic reaction. Can Med Assoc J 1983; 129: 854–5

    CAS  PubMed Central  PubMed  Google Scholar 

  35. Ruppert GB, Barth WF. Ibuprofen hypersensitivity in systemic lupus erythematosus. South Med J 1981; 74: 241–3

    CAS  PubMed  Google Scholar 

  36. Weksler BB, Lehany AM. Naproxen-induced recurrent aseptic meningitis. DICP 1991; 25: 1183–4

    CAS  PubMed  Google Scholar 

  37. Sylvia LM, Forlenza SW, Brocavich JM. Aseptic meningitis associated with naproxen. DICP 1988; 22: 399–401

    CAS  Google Scholar 

  38. Seaton RA, France AJ. Recurrent aseptic meningitis following non-steroidal anti-inflammatory drugs – a reminder. Postgrad Med J 1999; 75 (890): 771–2

    CAS  PubMed  Google Scholar 

  39. Ballas ZK, Donata ST. Sulindac-induced aseptic meningitis. Arch Intern Med 1982; 142: 165–6

    CAS  PubMed  Google Scholar 

  40. Lorino GD, Hardin JG. Sulindac-induced meningitis in mixed connective tissue disease. South Med J 1983; 76: 1185–7

    CAS  PubMed  Google Scholar 

  41. Greenberg GN. Recurrent sulindac-induced aseptic meningitis in a patient tolerant to other nonsteroidal anti-inflammatory drugs. South Med J 1988; 81: 1463–4

    CAS  PubMed  Google Scholar 

  42. von Reyn CF. Recurrent asepticmeningitis due to sulindac. Ann Intern Med 1983; 99: 343–4

    Google Scholar 

  43. Yasuda Y, Akiguchi I, KameyamaM. Sulindac-induced aseptic meningitis in mixed connective tissue disease. Clin Neurol Neurosurg 1989; 91 (3): 257–60

    CAS  Google Scholar 

  44. Roel JE, Gadano AC, Falcon JL. Ketoprofen and aseptic meningitis [letter]. Medicina 1991; 51 (2): 186

    CAS  PubMed  Google Scholar 

  45. Nair J, Stacy M. Aseptic meningitis associated with salicylate overdose [letter]. Psychosomatics 1993; 34 (4): 372

    CAS  PubMed  Google Scholar 

  46. O’BrienWM.Adverse reactions to nonsteroidal anti-inflammatory drugs: diclofenac as compared with other nonsteroidal anti-inflammatory drugs. Am J Med 1986; 80: 70–80

    CAS  Google Scholar 

  47. Codding C, Targoff IN, McCarty GA. Aseptic meningitis in association with diclofenac treatment in a patient with systemic lupus erythematosus. Arthritis Rheum 1991; 34 (10): 1340–1

    CAS  PubMed  Google Scholar 

  48. Ruppert GB, Barth WF. Tolmetin-induced aseptic meningitis. JAMA 1981; 245: 67–8

    CAS  PubMed  Google Scholar 

  49. Blumenfeld H, Cha JH, Cudkowicz ME. Trimethoprim and sulfonamide-associated meningoencephalitis with MRI correlates. Neurology 1996; 46: 556–8

    CAS  PubMed  Google Scholar 

  50. Birndorf LB, Kaufman DI. Aseptic meningitis with retinal ischemia due to trimethoprim-sulfamethoxazole. Neuroophthalmology 1991; 11: 215–22

    Google Scholar 

  51. Joffe AM, Farley JD, Linden D, et al. Trimethoprim-sulfamethoxazole- associated aseptic meningitis: case reports and review of the literature. Am J Med 1989; 87: 332–8

    CAS  PubMed  Google Scholar 

  52. Ansell G. Toxicity of opaque media used in X-ray diagnosis. In: Davies DM, editor. Toxicity of opaque media used in X-ray diagnosis: textbook of adverse drug reactions. New York: Oxford University Press, 1981: 576–95

    Google Scholar 

  53. Derbes SJ. Trimethoprim-induced aseptic meningitis. JAMA 1984; 252: 2865–6

    CAS  PubMed  Google Scholar 

  54. Jurado R, Carpenter SL, Rimland D. Case reports: trimethoprim- sulfamethoxazole-induced meningitis in patients with HIV infection. Am J Med Sci 1996; 312 (1): 27–9

    CAS  PubMed  Google Scholar 

  55. Tunkel AR, Starr K. Trimethoprim-sulfamethoxazole-associated aseptic meningitis. Am J Med 1990; 88 (6): 696–7

    CAS  PubMed  Google Scholar 

  56. Kremer I, Ritz R, Brunner F. Aseptic meningitis as an adverse effect of co-trimoxazole [letter]. N Engl J Med 1983; 308 (24): 1481

    Google Scholar 

  57. Haase DA, Harding GKM, Thomson MJ, et al. Comparative trial of norfloxacin and trimethoprim-sulfamethoxazole in the treatment of women with localised, acute, symptomatic urinary tract infections and antimicrobial effect of periurethral and fecal microflora. Antimicrob Agents Chemother 1984; 26: 481–4

    CAS  PubMed Central  PubMed  Google Scholar 

  58. Lee BW, Tan JA, Wong SC, et al. The diagnosis of tuberculous meningitis using the polymerase chain reaction [see comments]. Singapore Med J 1994; 35 (4): 360–3

    CAS  PubMed  Google Scholar 

  59. Biosca M, de la Figuera M, Garcia-Bragado F, et al. Aseptic meningitis due to trimethoprim-sulfamethoxazole. J Neurol Neurosurg Psychiatry 1986; 49: 332–3

    CAS  PubMed  Google Scholar 

  60. Streiffer RH, Hudson JG. Aseptic meningitis and trimethoprimsulfamethoxazole [letter]. J Fam Pract 1986; 23 (4): 314

    Google Scholar 

  61. Carlson J, Wiholm BE. Trimethoprim associated aseptic meningitis. Scand J Infect Dis 1987; 19: 687–91

    CAS  PubMed  Google Scholar 

  62. Hedlund J, Aurelius E, Andersson J. Recurrent encephalitis due to trimethoprim intake. Scand J Infect Dis 1990; 22 (1): 109–12

    CAS  PubMed  Google Scholar 

  63. Auxier GG. Aseptic meningitis associated with administration of trimethoprim and sulfamethoxazole [letter]. Am J Dis Child 1990; 144 (2): 144–5

    CAS  PubMed  Google Scholar 

  64. Escalante A, Stimmler MM. Trimethoprim-sulfamethoxasole induced meningitis in systemic lupus erythematosus. J Rheumatol 1992; 19 (5): 800–2

    CAS  PubMed  Google Scholar 

  65. Pashankar D, McArdle M, Robinson A. Co-trimoxazole induced aseptic meningitis. Arch Dis Child 1995; 73 (3): 257–8

    CAS  PubMed  Google Scholar 

  66. Rudy BJ, Rutstein R. Aseptic meningitis from trimethoprimsulfamethoxazole in an HIV-infected adolescent. Pediatri Emerg Care 1997; 13 (3): 216–7

    CAS  Google Scholar 

  67. Gordon MF, Allon M, Coyle PK. Drug-induced meningitis. Neurology 1990; 40 (1): 163–4

    CAS  PubMed  Google Scholar 

  68. Gilroy N, Gottlieb T, Spring P, et al. Trimethoprim-induced aseptic meningitis [letter]. Lancet 1997; 350 (9071): 112

    Google Scholar 

  69. de la Monte SM, Hutchins GM, Gupta PK. Aseptic meningitis, trimethoprim, and Sjogren’s syndrome [letter]. JAMA 1985; 253 (15): 2192

    Google Scholar 

  70. Harrison MS, Simonte SJ, Kauffman CA. Trimethoprim-induced aseptic meningitis in a patient with AIDS: case report and review. Clin Infect Dis 1994; 19 (3): 431–4

    CAS  PubMed  Google Scholar 

  71. Asperilla MO, Smego RA. Eosinophilic meningitis associated with ciprofloxacin. Am J Med 1989; 87: 589–90

    CAS  PubMed  Google Scholar 

  72. Garagusi VF, Neefe LI, Mann O. Acute meningoencephalitis associated with isoniazid administration. JAMA 1976; 235: 1141–2

    CAS  PubMed  Google Scholar 

  73. Farmer L, Echlin FA, Loughlin WC, et al. Pachymeningitis apparently due to penicillin hypersensitivity. Ann Intern Med 1960; 52: 910–4

    CAS  PubMed  Google Scholar 

  74. Creel GB, Hurtt M. Cephalosporin-induced recurrent aseptic meningitis. Ann Neurol 1995; 37 (6): 815–7

    CAS  PubMed  Google Scholar 

  75. Corson AP, Chretien JH. Metronidazole-associated aseptic meningitis [letter]. Clin Infect Dis 1994; 19 (5): 974

    Google Scholar 

  76. Buckley RM,WattersW, MacGregor RR. Persistent meningeal inflammation associated with intrathecal gentamicin. Am J Med Sci 1977; 274 (2): 207–9

    CAS  Google Scholar 

  77. Sekul EA, Cupler EJ, Dalakas MC. Aseptic meningitis associated with high-dose intravenous immunoglobulin therapy: frequency and risk factors. Ann Intern Med 1994; 121 (4): 259–62

    CAS  PubMed  Google Scholar 

  78. Pallares DE, Marshall GS. Acute aseptic meningitis associated with administration of intravenous immune globulin [letter]. Am J Pediatr Hematol Oncol 1992; 14 (3): 279

    Google Scholar 

  79. Casteels-Van DM, Wijndaele L, Brock P, et al. Aseptic meningitis associated with high dose intravenous immunoglobulin therapy [letter, comment]. J Neurol Neurosurg Psychiatry 1992; 55 (10): 980–1

    Google Scholar 

  80. Watson JD, Gibson J, Joshua DE, et al. Aseptic meningitis associated with high dose intravenous immunoglobulin therapy. J Neurol Neurosurg Psychiatry 1991; 54 (3): 275–6

    CAS  PubMed  Google Scholar 

  81. Kato E, Shindo S, Eto Y, et al. Administration of immune globulin associated with aseptic meningitis. JAMA 1988; 259 (22): 3269–71

    CAS  PubMed  Google Scholar 

  82. Ozsoylu S. Aseptic meningitis and intravenous gammaglobulin treatment. Am J Dis Child 1993; 147 (2): 129–30

    CAS  PubMed  Google Scholar 

  83. Kressebuch I, Ritz R, Brunner F. Cerebrospinal fluid inflammation induced by intravenous immunoglobulins. Pediatr Dis J 1992; 11 (10): 894–5

    CAS  Google Scholar 

  84. De Vlieghere FC, Peetermans WE, Vermylen J. Aseptic granulocytic meningitis following treatment with intravenous immunoglobulin. Clin Infect Dis 1994; 18 (6): 1008–10

    PubMed  Google Scholar 

  85. Misbah SA, Chapel HM. Adverse effects of intravenous immunoglobulin. Drug Saf 1993; 9: 254–62

    CAS  PubMed  Google Scholar 

  86. Picton P, Chisholm M. Aseptic meningitis associated with high dose immunoglobulin: case report. BMJ 1997; 315 (7117): 1203–4

    CAS  PubMed  Google Scholar 

  87. Ellis RJ, Swendson MR, Bajorek J. Aseptic meningitis as a complication of intravenous immunoglobulin therapy for myasthenia gravis. Muscle Nerve 1994; 17: 683–4

    CAS  PubMed  Google Scholar 

  88. Kattamis AC, Shankar S, Cohen AR. Neurologic complications of treatment of childhood acute immune thrombocytopenic purpura with intravenously administered immunoglobulin G. J Pediatr 1997; 130: 281–3

    CAS  PubMed  Google Scholar 

  89. Lafferty TE, DeHoratius RJ, Smith JB. Aseptic meningitis as a side effect of intravenous immune gammaglobulin [letter]. J Rheumatol 1997; 24: 2491–2

    CAS  PubMed  Google Scholar 

  90. Meiner Z, Ben-Hur T, River Y, et al. Aseptic meningitis as complication of intravenous immunoglobulin therapy for myasthenia gravis [letter]. J Neurol Neurosurg Psychiatry 1993; 56: 830–1

    CAS  PubMed  Google Scholar 

  91. Mitterer M, Pescosta N, Vogetseder W, et al. Two episodes of aseptic meningitis during intravenous immunoglobulin ther- apy of idiopathic thrombocytopenic purpura [letter]. Ann Hematol 1993; 67: 151–2

    CAS  PubMed  Google Scholar 

  92. Molina JM, Coffineau A, Rain JD, et al. Aseptic meningitis following administration of intravenous immune globuline [letter]. Clin Infect Dis 1992; 15: 564–5

    CAS  PubMed  Google Scholar 

  93. Preminger-Shapiro R, Nussinovitch M, Soen G, et al. Aseptic meningitis: a frequent side-effect of intravenous immunoglobulin? [letter]. Eur Pediatr 1995; 154: 866–7

    CAS  Google Scholar 

  94. Rao SP, Teitlebaum J, Miller ST. Intravenous immune globulin and aseptic meningitis [letter; published erratum appears in Am J Dis Child 1992; 196 (2): 147]. Am J Dis Child 1992; 146: 539-40

    CAS  PubMed  Google Scholar 

  95. Shorr AF, Kester KE. Meningitis and hepatitis complicating intravenous immunoglobulin therapy. Ann Pharmacother 1996; 30: 1115–6

    CAS  PubMed  Google Scholar 

  96. Vera-ramirez M, Charlet M, Parry GJ. Recurrent aseptic meningitis complicating intravenous immunoglobulin therapy for chronic inflammatory demyelinating polyradiculoneuropathy. Neurology 1992; 42: 1636–7

    CAS  PubMed  Google Scholar 

  97. Mselati JC, Carlier JC, Routon MC, et al. Intravenous immunoglobulins and aseptic meningitis [letter]. Arch Fr Pediatr 1992; 49 (3): 216

    Google Scholar 

  98. Schiavotto C, RuggeriM, Rodeghiero F.Adverse reactions after high-dose intravenous immunoglobulin: incidence in 83 patients treated for idiopathic thrombocytopenic purpura (ITP) and review of the literature. Haematologica 1993; 78 (6 Suppl. 2): 35–40

  99. Jolles S, Hill H. Management of aseptic meningitis secondary to intravenous immunoglobulin [letter, comment]. BMJ 1998; 316 (7135): 936

    Google Scholar 

  100. Nydegger UE. Safety and side effects of i.v. immunoglobulin therapy. Clin Exp Rheumatol 1996; 14 Suppl. 15: 53S–57S

    Google Scholar 

  101. McBeath AA. Eosinophilic meningitis followingmyelography. JAMA 1980; 243: 22–4

    Google Scholar 

  102. Kalyanaraman K. Eosinophilic meningitis after repeated lophendylate injection myelography [letter]. Arch Neurol 1980; 37 (9): 602

    CAS  PubMed  Google Scholar 

  103. Kelley RE, Daroff RB, SheremataWA, et al. Unusual effects of metrizamide lumbar myelography: constellation of aseptic meningitis, arachnoiditis, communicating hydrocephalus, and Guillaine-Barre syndrome. Arch Neurol 1980; 37 (9): 588–9

    CAS  PubMed  Google Scholar 

  104. Teplic JG, Haskin ME, Skelley JF. Total myelography with radiopaque emulsions. Radiology 1968; 90: 698–704

    Google Scholar 

  105. DiMario Jr FJ. Aseptic meningitis secondary to metrizamide lumbar myelography in a 41⁄2-month-old infant. Pediatrics 1985; 76 (2): 259–62

    PubMed  Google Scholar 

  106. Sand T, Anda S, Hellum K, et al. Chemical meningitis in metrizamide myelography. Neuroradiology 1986; 28: 67–71

    Google Scholar 

  107. Gelmers HJ. Exacerbation of systemic lupus erythematosus, aseptic meningitis and acute mental symptoms, following metrizamide lumbar myelography. Neuroradiology 1984; 26 (1): 65–6

    CAS  PubMed  Google Scholar 

  108. Thordarson H, Talstad I. Acute meningitis and cerebellar dysfunction complicating high-dose cytosine arabinoside therapy. ActaMed Scand 1986; 220 (5): 493–5

    CAS  PubMed  Google Scholar 

  109. Forster G, Sacks S, Christoff N. Aseptic meningitis as a complication of scinticysternography utilizing 111indium-DTPA. Clin Neurol Neurosurg 1975; 78 (4): 289–92

    CAS  PubMed  Google Scholar 

  110. Baker FJ, Gossen G, Bertoni JM. Aseptic meningitis complicating metrizamide myelography. Am J Neuroradiol 1982; 3 (6): 662–3

    CAS  PubMed  Google Scholar 

  111. Spencer CP, Chrisman CL,Mayhew IG, et al. Neurotoxicologic effects of the nonionic contrast agent iopamidol on the leptomeninges of the dog. Am J Vet Res 1982; 43 (11): 1958–62

    CAS  PubMed  Google Scholar 

  112. Eustace S, Buff B. Magnetic resonance imaging in drug-induced meningitis. Can Assoc Radiol J 1994; 45 (6): 463–5

    CAS  PubMed  Google Scholar 

  113. Goldstein NP, McKenzie BF,McGukin WF, et al. Experimental intrathecal administration of methylprednisolone acetate in multiple sclerosis. Trans Am Neurol Assoc 1970; 95: 243–4

    CAS  PubMed  Google Scholar 

  114. Sehgal AD, Tweed DC, Gardner WJ, et al. Laboratory studies after intrathecal corticosteroids. Arch Neurol 1963; 9: 74–8

    Google Scholar 

  115. PlumbVJ, DismukesWE. Chemical meningitis related to itrathecal corticosteroid therapy. South Med J 1977; 70: 1241–3

    Google Scholar 

  116. Gutknecht DR. Chemical meningitis following epidural injections of corticosteroids [letter]. Am J Med 1987; 82: 570

    CAS  PubMed  Google Scholar 

  117. Stratton I. Dangers of intrathecal hydrocortisone sodium succinate [letter]. Med J Aust 1975; 18 (2): 650

    Google Scholar 

  118. Mott MG, Stevenson P, Wood CB. Methotrexate meningitis. Lancet 1972; II (7778): 656

  119. Salinsky MC, Levine RL, Aubuchon JP, et al. Acute cerebellar dysfunction after high-dose ARA-C therapy. Cancer 1983; 51: 426–9

    CAS  PubMed  Google Scholar 

  120. Winkelman MD, Hines JD. Cerebellar degeneration caused by high-dose cytosine arabinoside: a clinicopathological study. Ann Neurol 1983; 14: 520–7

    CAS  PubMed  Google Scholar 

  121. Lazarus HM, Herzig RH, Herzig GP, et al. Central nervous system toxicity of high-dose systemic cytosine arabinoside. Cancer 1981; 48: 2577–82

    CAS  PubMed  Google Scholar 

  122. Band PR, Holland JF, Bernard J, et al. Treatment of central nervous system leukemia with intrathecal cytosine arabinoside. Cancer 1973; 32: 744–8

    CAS  PubMed  Google Scholar 

  123. Wolff L, Zighelboim J, Gale RP. Paraplegia following intrathecal cytosine arabinoside. Cancer 1979; 43: 83–5

    CAS  PubMed  Google Scholar 

  124. Wang JJ, Pratt CB. Intrathecal arabinosyl cytosine in meningeal leukemia. Cancer 1970; 25: 531–4

    CAS  PubMed  Google Scholar 

  125. Obwegeser A, Seiwald M, Stockhammer G. Intraventricular chemotherapy. J Neurosurg 1998; 89 (1): 172–3

    CAS  PubMed  Google Scholar 

  126. Naveira FA, Speight KL, Rauck RL, et al. Meningitis after injection of intrathecal baclofen. Anesth Analg 1996; 82 (6): 1297–9

    CAS  PubMed  Google Scholar 

  127. Goldman WW, Sanford JP. An epidemic of chemical meningitis. Am J Med 1960; 29: 94–101

    PubMed  Google Scholar 

  128. Gibbons RB. Chemical meningitis following spinal anesthesia. JAMA 1960; 29: 94–101

    Google Scholar 

  129. Dunkley B, Lewis TT. Meningeal reaction to starch powder in the cerebrospinal fluid. BMJ 1977; 2: 1391–2

    CAS  PubMed  Google Scholar 

  130. Miller E, Goldacre M, Pugh S, et al. Risk of aseptic meningitis after measles, mumps, and rubella vaccine in UK children. Lancet 1993; 341 (8851): 979–82

    CAS  PubMed  Google Scholar 

  131. Nalin DR. Mumps vaccine meningitis: which strain? [letter, comment]. Lancet 1989; 2 (8676): 1396

    Google Scholar 

  132. Cizman M, Mozetic M, Radescek-Rakar R, et al. Aseptic meningitis after vaccination against measles and mumps. Pediatr Infect Dis J 1989; 8 (5): 302–8

    CAS  PubMed  Google Scholar 

  133. Tesovic G, Begovac J, Bace A. Aseptic meningitis after measles, mumps, and rubella vaccine [letter, comment]. Lancet 1993; 341 (8859): 1541

    Google Scholar 

  134. Fujinaga T,MotegiY, TamuraH, et al.Aprefecture-wide survey of mumps meningitis associated with measles, mumps and rubella vaccine. Pediatr Infect Dis J 1991; 10 (3): 204–9

    CAS  PubMed  Google Scholar 

  135. Howson CP, Fineberg HV. Adverse events following pertussis and rubella vaccines [Institute of Medicine summary report]. JAMA 1992; 267: 392–6

    CAS  PubMed  Google Scholar 

  136. Heinzlef O, Moguilewski A, Roullet E. Acute aseptic meningitis after hepatitis B vaccination [letter]. Presse Med 1997; 26 (7): 328

    CAS  PubMed  Google Scholar 

  137. Hilton E, Stroh EM. Aseptic meningitis associated with administration of carbamazepine. J Infect Dis 1989; 159: 363–4

    CAS  PubMed  Google Scholar 

  138. Simon LT, Hsu B, Adornato BT. Carbamazepine-induced aseptic meningitis. Ann Intern Med 1990; 112 (8): 627–8

    CAS  PubMed  Google Scholar 

  139. Hemet C, Chassagne P, Levade MH, et al. Aseptic meningitis secondary to carbamazepine treatment of manic-depressive illness [letter]. Am J Psychiatry 1994; 151 (9): 1393

    CAS  PubMed  Google Scholar 

  140. Dang CT, Riley DK. Aseptic meningitis secondary to carbamazepine therapy. Clin Infect Dis 1996; 22 (4): 729–30

    CAS  PubMed  Google Scholar 

  141. Emmons C, Smith J, Flanigan M. Cerebrospinal fluid inflammation during OKT3 therapy. Lancet 1986; II (8505): 510–1

    Google Scholar 

  142. Roden J, Klintmalm GB, Husberg BS, et al. Cerebrospinal fluid inflammation during OKT3 therapy. Lancet 1987; II: 272–3

    Google Scholar 

  143. Martin MA, Massanari RM, Nghiem DD, et al. Nosocomial aseptic meningitis associated with administration of OKT3. JAMA 1988; 259 (13): 2002–5

    CAS  PubMed  Google Scholar 

  144. Thistlethwaite JR, Stuart JK,Mayes JT, et al. Complications and monitoring of OKT3 therapy. Am J Kidney Dis 1988; 11 (2): 112–9

    PubMed  Google Scholar 

  145. Joy ME,MichalsML, Canafax DM. Aseptic meningitis associatedwithmuromonab- CD3 therapy [letter]. Clin Pharm 1988; 7 (10): 721

    CAS  PubMed  Google Scholar 

  146. Rello J, Vallverdu I, Coll P, et al. Aseptic meningitis associated with muromonab-CD3 [letter]. DICP 1990; 24 (12): 1233

    CAS  PubMed  Google Scholar 

  147. Sutton JD, Prioleau MH, Wordell CJ, et al. Aseptic meningitis associated with muromonab CD3 administration. DICP 1989; 23 (3): 257–8

    CAS  PubMed  Google Scholar 

  148. Paap CM. Comment: muromonab CD3 aseptic meningitis. DICP 1989; 23 (9): 716–7

    CAS  PubMed  Google Scholar 

  149. Drees C, Haley CJ. Aseptic meningitis and muromonab-CD3 therapy. DICP 1991; 25 (2): 138–9

    CAS  PubMed  Google Scholar 

  150. Adair JC,Woodley SL, O’Connell JB, et al. Aseptic meningitis following cardiac transplantation: clinical characteristics and relationship to immunosuppressive regimen. Neurology 1991; 41 (2 Pt 1): 249–52

    CAS  PubMed  Google Scholar 

  151. Uribe RM, Zurru MC, Gatto EM, et al. Aseptic meningitis due to OKT3. Neurologia 1998; 13 (2): 98–9

    Google Scholar 

  152. Kreis H. Adverse events associated with OKT3 immunosuppression in the prevention or treatment of allograft-rejection. Clin Transplant 1993; 7: 431–46

    Google Scholar 

  153. Sergent JS, Lockshin M. Azathioprine-induced meningitis in systemic lupus erythematosus [letter]. JAMA1978; 240 (6): 529

    CAS  PubMed  Google Scholar 

  154. Falloon J,Owen C, Kovacs, et al.MK-639 (MerckHIVprotease inhibitor) with interleukin-2 (IL2) in HIV. Program and abstracts of the 35th Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC); 1995 Sep 17–20, 1995, San Francisco (CA): American Society of Microbiology (electronic version), Abstracts-On-Disk (R), Marathon Multimedia, Northfield, MN, 1995

  155. Durand JM, Suchet L, Morange S, et al. Ranitidine and aseptic meningitis. BMJ 1996; 312 (7035): 886

    Google Scholar 

  156. Merrin P,Williams IA. Meningitis associated with sulphasalazine in a patient with Sjogren’s syndrome and polyarthritis. Ann Rheum Dis 1991; 50 (9): 645–6

    CAS  PubMed  Google Scholar 

  157. Alloway JA, Mitchell SR. Sulfasalazine neurotoxicity: a report of aseptic meningitis and a review of the literature [letter]. J Rheumatol 1993; 20 (2): 409–11

    CAS  PubMed  Google Scholar 

  158. Herlihy TE. Phenazopyridine and aseptic meningitis. Ann Intern Med 1987; 106 (1): 172–3

    CAS  PubMed  Google Scholar 

  159. Bodokh I, Lacour JP, Costa I, et al. Aseptic meningitis during pyrazinamide therapy for lupus erythematosus. Presse Med 1993; 22 (12): 595–6

    CAS  PubMed  Google Scholar 

  160. Nicol CF. Asecond case of aseptic meningitis following isotope cisternography using I131 human serum albumin. Neurology 1967; 17: 199–200

    CAS  PubMed  Google Scholar 

  161. Diaz-Gonzalez F, Sanchez-Madrid F. Inhibition of leucocyte adhesion: an alternative mechanism of action for anti-inflammatory drugs. Immunol Today 1998; 19: 169–72

    CAS  PubMed  Google Scholar 

  162. Moris G, Garcia-Monco JC. The challenge of drug-induced aseptic meningitis. Arch Intern Med 1999; 159: 1185–94

    CAS  PubMed  Google Scholar 

Download references

Acknowledgements

We wish to thank Dr Jenny Hughes for her careful reading and constructive criticism of the manuscript.

Author information

Authors and Affiliations

  1. Division of Cellular Immunology, National Institute for Medical Research, The Ridgeway, Mill Hill, London, NW7 1AA, England

    Stephen Jolles

  2. Department of Immunology, Royal Free & University College Medical School, London, England

    W. A. Carrock Sewell

  3. Department of Pharmacy, Royal Free & University College Medical School, London, England

    Carol Leighton

Authors
  1. Stephen Jolles
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. W. A. Carrock Sewell
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Carol Leighton
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Stephen Jolles.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Jolles, S., Sewell, W.A.C. & Leighton, C. Drug-Induced Aseptic Meningitis. Drug-Safety 22, 215–226 (2000). https://doi.org/10.2165/00002018-200022030-00005

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00002018-200022030-00005

Keywords

Search

Navigation