1/39. A rare case of cotrimoxazole-induced eosinophilic aseptic meningitis in an hiv-infected patient.A case of cotrimoxazole-induced meningoencephalitis in an hiv-infected patient without signs of AIDS is reported. The patient developed an apparently generalized seizure, of cotrimoxazole, 1 month after first taking a dose of this drug and a febrile coma after a second dose 3 weeks later. Lumbar puncture revealed eosinophilic aseptic meningitis. The patient quickly recovered without sequelae and was given antiretroviral therapy plus pentamidine aerosolized and pyrimethamine as prophylaxis for opportunistic infections. No other adverse effects were observed. The report describes the diagnosis of this case supported by a commentary, including a literature review.- - - - - - - - - - ranking = 1keywords = drug (Clic here for more details about this article) |
2/39. Aseptic meningitis in the newborn and young infant.When a toxic newborn or young infant presents with fever and lethargy or irritability, it is important to consider the diagnosis of meningitis even if the classic localizing signs and symptoms are absent. cerebrospinal fluid should be obtained (unless lumbar puncture is clinically contraindicated) to enable initial therapy to be planned. Initial results of cerebrospinal fluid testing may not conclusively differentiate between aseptic and bacterial meningitis, and antimicrobial therapy for all likely organisms should be instituted until definitive culture results are available. Comprehensive therapy, including antibacterial and antiviral agents, should continue until a cause is identified and more specific therapy is initiated, an etiology is excluded or the patient improves considerably and the course of antimicrobial therapy is completed. Group B streptococcus is the most common bacterial etiologic agent in cases of meningitis that occur during the first month after birth. Etiologies of aseptic meningitis include viral infection, partially treated bacterial meningitis, congenital infections, drug reactions, postvaccination complications, systemic diseases and malignancy. Long-term sequelae of meningitis include neuromuscular impairments, learning disabilities and hearing loss. Prompt diagnosis and treatment are essential to improved outcome.- - - - - - - - - - ranking = 1keywords = drug (Clic here for more details about this article) |
3/39. adult onset Still's disease presenting as aseptic meningitis in a young healthy female.A 20-year-old white female presented with symptoms of upper respiratory tract infection, meningeal signs, rash, and fever. Initial laboratory data revealed a leukocytosis and abnormal CSF. An initial working diagnosis of the Aseptic meningitis syndrome was made. She did not respond to antimicrobial therapy. All culture results and viral titers were negative. One week into her hospital course, the diagnosis of adult Onset Still's disease (AOSD) was made. Antibiotics were discontinued and nonsteroidal anti-inflammatory drugs (NSAIDS) begun. The patient showed marked improvement within 24 hours. This case reveals that AOSD is an important consideration in the differential diagnosis of Aseptic meningitis. Meningeal signs and abnormal cerebrospinal fluid (CSF), both detected in this patient, are very rare occurrences in Still's disease.- - - - - - - - - - ranking = 1keywords = drug (Clic here for more details about this article) |
4/39. Kikuchi's disease with multisystemic involvement and adverse reaction to drugs.Kikuchi's disease (KD), or histiocytic necrotizing lymphadenitis, was initially described in japan in 1972. In the following years, several series of cases involving patients of different ages, races, and geographic origins were reported, but pediatric reports have been rare. The etiology of KD is unknown, although a viral or autoimmune hypothesis has been suggested. The most frequent clinical manifestation consists of local or generalized adenopathy, although in some cases, it is associated with more general symptoms, multiorganic involvement, and diverse analytic changes (leukopenia, elevated erythrocyte sedimentation rate, and c-reactive protein, as well as an increase of transaminases and serum lactic dehydrogenase). diagnosis is based on characteristic pathologic findings that permit differentiation of this disease from lymphoma, systemic lupus erythematosus, and infectious lymphadenopathies. We present here the case of a 14-year-old boy who presented with severe systemic manifestations and transient fulminant hepatic failure in response to treatment with antituberculosis drugs. Kikuchi's disease, lymphadenitis, liver failure, antituberculosis drugs.- - - - - - - - - - ranking = 6keywords = drug (Clic here for more details about this article) |
5/39. Recurrent aseptic meningitis following non- steroidal anti-inflammatory drugs--a reminder.Non-steroidal anti-inflammatory drugs (NSAIDs) are rarely associated with side-effects affecting the central nervous system. A case of NSAID-induced recurrent aseptic meningitis is presented. Seven episodes of aseptic meningitis were documented in the patient's life-time (up to the age of 30). general practitioners' records available for the latest four episodes showed that a NSAID (naproxen, piroxicam or diclofenac) was prescribed in the month prior to admission on each occasion. The patient was symptom free for a 3-year period during which no NSAID was prescribed. Clinicians should always elicit a careful drug history (including over-the-counter medications) in patients with aseptic meningitis and be aware of this unusual side-effect of NSAIDs.- - - - - - - - - - ranking = 6keywords = drug (Clic here for more details about this article) |
6/39. trimethoprim-sulfamethoxazole-induced aseptic meningitis: case report and literature review.Aseptic meningitis is a rare adverse drug reaction, reported with non-steroidal anti-inflammatory agents (NSAIDs) and with miscellaneous drugs such as trimethoprim-sulfamethoxazole (TMP-SMX). The most common clinical findings reported are fever, headache, stiffness and altered level of consciousness. We report a case of aseptic meningitis related to TMP-SMX ingestion that caused severe derangements of the patient's vital signs, requiring intensive care Unit admittance. The prompt diagnosis and discontinuation of the drug resulted in complete recovery. We examine the case according to the literature on this topic. We conclude that, since the signs and symptoms of this unusual drug reaction may mimic those of central nervous system infection, the clinician should consider this etiology when he is faced with a patient with suspected meningoencephalitis, especially if the latter has already been treated at home with unknown drugs. Further studies should investigate the pathogenetic mechanism of TMP-SMX-induced aseptic meningitis.- - - - - - - - - - ranking = 5keywords = drug (Clic here for more details about this article) |
7/39. recurrence of ibuprofen-induced aseptic meningitis in an otherwise healthy patient.We report the case of a 74-year-old woman who had three episodes of aseptic meningitis in a period of 20 years. These episodes always occurred a few hours after the assumption of a non-steroidal anti-inflammatory drug (NSAID) per os. Nevertheless, the pharmacological anamnesis did not receive proper attention, neither the first nor the second time, and the meningeal syndrome with aseptic liquor was attributed to a viral aggression. However, when the third episode occurred, due to the strict time correlation between the assumption of the drug and the occurrence of symptoms, both the results of the liquoral analysis and the anamnestic records allowed recognition of ibuprofen as the cause of acute meningitis.- - - - - - - - - - ranking = 2keywords = drug (Clic here for more details about this article) |
8/39. trimethoprim-sulfamethoxazole induced aseptic meningitis in a renal transplant patient.A 45-year-old man underwent renal transplant for end-stage renal disease complicating systemic lupus erythematosis. Within 24 hours of initiating pneumocystis carinii pneumonia (PCP) prophylaxis with trimethoprim-sulfamethoxazole (TMP-SMX) he developed fever and confusion. cerebrospinal fluid examination revealed a pleocytosis but cultures were negative. The patient improved within three days after cessation of the TMP-SMX but symptoms recurred rapidly upon drug rechallenge. Drug-induced aseptic meningitis is an uncommon but well described clinical entity. This is the first case described in a patient following renal transplantation. The literature is reviewed and the clinical features, diagnostic challenges and possible mechanisms of TMP-SMX-induced aseptic meningitis are discussed. This problem may be more common in the transplant population than is recognized given the difficulty of diagnosis combined with the widespread use of TMP-SMX as PCP prophylaxis.- - - - - - - - - - ranking = 1keywords = drug (Clic here for more details about this article) |
9/39. Suspected allopurinol-induced aseptic meningitis.Drug-induced aseptic meningitis is a syndrome with symptoms similar to those of infectious meningitis. A 60-year-old man with a history of recurrent renal stones was admitted to the hospital with fever, chills, and mental status changes after taking levofloxacin, allopurinol, and acetazolamide. No infectious source was identified. Once home, he resumed allopurinol, and within 2 hours, he experienced the same symptoms, requiring rehospitalization. He was diagnosed with suspected meningitis from an adverse drug reaction that we believe was due to allopurinol. It is important to remember, when all other causes are ruled out, that a patient's symptoms may be a drug-induced adverse effect. Drug-induced aseptic meningitis should be considered when patients with symptoms similar to those of infectious meningitis appear without infectious etiologies or cerebrospinal fluid pleocytosis, a suspected agent was recently started, and resolution of adverse effects occurs when the agent is withdrawn.- - - - - - - - - - ranking = 2keywords = drug (Clic here for more details about this article) |
10/39. Infliximab-induced aseptic meningitis.We report an episode of aseptic meningitis in a 53-year-old man, who was treated with infliximab for active rheumatoid arthritis. He had acute, severe muscle pain after initial infusion of the drug, and similar symptoms with a transient lymphocytic meningitis after a subsequent infusion. We measured no change in antibodies to nuclei, dna, or to neurones. Functional antibodies to infliximab were not induced and concentrations of tumour necrosis factor a in spinal fluid were not raised. This adverse reaction to infliximab might have been caused by inability of the drug to enter the central nervous system.- - - - - - - - - - ranking = 2keywords = drug (Clic here for more details about this article) |
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