Drug induced aseptic meningitis: Difference between revisions
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*Higher predominance in SLE and female gender | *Higher predominance in SLE and female gender | ||
==Causes== | ===Causes=== | ||
*[[NSAIDs]] | *[[NSAIDs]] | ||
**Most common cause | **Most common cause | ||
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**[[Allopurinol]] | **[[Allopurinol]] | ||
==Clinical | ==Clinical Freatures== | ||
*[[Headache]] | *[[Headache]] | ||
*[[Fever]] | *[[Fever]] | ||
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*Less common symptoms include rash, arthralgia, myalgia, facial edema | *Less common symptoms include rash, arthralgia, myalgia, facial edema | ||
==Diagnosis== | ==Differential Diagnosis== | ||
==Evaluation== | |||
*Drug history with focus on time of ingestion and symptom onset | *Drug history with focus on time of ingestion and symptom onset | ||
*CSF studies | *CSF studies | ||
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**Due to associated risk, should only be done if suspected drug is irreplaceable | **Due to associated risk, should only be done if suspected drug is irreplaceable | ||
== | ==Management== | ||
*Discontinuation of offending agent | *Discontinuation of offending agent | ||
==Disposition== | |||
==See Also== | |||
==References== | ==References== | ||
<references/> | |||
[[Category:ID]] | |||
[[Category:Pharmacology]] | |||
Revision as of 05:43, 7 September 2017
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
- NSAIDs
- Most common cause
- Antibiotics
- Immunoregulating agents
- IVIGs
- OKT3 monoclonal antibodies
- Misc
Clinical Freatures
- Headache
- Fever
- Nuchal rigidity
- Nausea/vomiting
- General malaise
- Altered mental status
- Less common symptoms include rash, arthralgia, myalgia, facial edema
Differential Diagnosis
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