Drug induced aseptic meningitis: Difference between revisions
| Line 38: | Line 38: | ||
*General malaise | *General malaise | ||
*Less common symptoms include rash, arthralgia, myalgia, facial edema | *Less common symptoms include rash, arthralgia, myalgia, facial edema | ||
==Diagnosis== | |||
*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 | |||
Revision as of 18:38, 1 September 2017
Background
- Abbreviation: DIAM
- Two proposed mechanisms
- Direct meningeal irritation by intrathecal drug
- Hypersensitivity reaction to drug (type III and IV)
Causes
- NSAIDs
- Most common cause
- Antibiotics
- Immunoregulating agents
- IVIGs
- OKT3 monoclonal antibodies
- Misc
Clinical presentation
- Headache
- Fever
- Nuchal rigidity
- Nausea/vomiting
- General malaise
- Less common symptoms include rash, arthralgia, myalgia, facial edema
Diagnosis
- 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