ABSTRACT. Drug-induced aseptic meningitis attributable to trimethoprim alone has only rarely been documented in the literature. A previously healthy adolescent male presented to our hospital with recurrent headaches, photophobia, and meningismus after serially starting and stopping trimethoprim. Cerebrospinal fluid studies revealed elevated white blood cell counts with a polymorphonuclear predominance. This case is the second documented report of trimethoprim-induced aseptic meningitis in a pediatric patient. Pediatrics 2002;110(2). URL: http://www.pediatrics.org/cgi/content/full/110/2/ e26; aseptic meningitis, trimethoprim.ABBREVIATIONS. LP, lumbar puncture; WBC, white blood cell; PMN, polymorphonuclear leukocytes; CSF, cerebrospinal fluid.A septic meningitis is associated with a wide variety of infectious and noninfectious processes. Adverse drug reactions presenting as aseptic meningitis have been well documented and pose a considerable diagnostic challenge to the clinician. 1 The most common medications associated with this syndrome include nonsteroidal antiinflammatory drugs, intravenous immunoglobulin, muromonab-CD3 (OKT3), and numerous antibiotics. 2 Aseptic meningitis attributable to trimethoprim alone has been described in the adult population. [3][4][5] A careful search of the literature, however, revealed only 1 documented pediatric case. 4 We report a case of trimethoprim-induced aseptic meningitis in an adolescent male. CASE REPORTA 15-year-old male was prescribed trimethoprim, 200 mg in the morning and 100 mg in the evening, for acne. After 1 month, he discontinued the medication for no apparent reason. At that time the patient was asymptomatic. One month later the patient resumed the medication. Within 2 days, he noted headache, nausea, neck pain, numbness in his extremities, photophobia, subjective fever, and red eyes. The patient discontinued his trimethoprim again, this time because of the above noted adverse reaction. His symptoms resolved within 24 hours without his seeking medical assistance.One week later, the patient resumed the trimethoprim, starting with the evening dose. By the next morning, before taking a second dose of trimethoprim, the patient's previously described symptoms had recurred. These symptoms were described as more severe than the initial episode.The patient's primary care physician referred him to the local emergency department for a lumbar puncture (LP). The LP revealed glucose of 62 mg/dL, protein of 85 mg/dL, and 38 white blood cells (WBCs) with a differential of 99% polymorphonuclear leukocytes (PMNs) and 1% lymphocytes. Gram-stain and culture of the cerebrospinal fluid (CSF) were negative.The patient discontinued the trimethoprim again. However, his headache persisted for 3 days, necessitating a second emergency department visit. A second LP was not performed at this time, but CSF cultures from the previous visit remained negative. Tylenol #3 was prescribed, the patient returned home, and his symptoms resolved.Twelve days later, the patient felt well and again resum...
Applicants whose departmental advisors serve on a residency selection committee have less confidence in the advising relationship. These interactions may have adverse effects on the clinical and professional development of medical students.
Communication between applicants and programs during the Match varies and may have adverse effects on the ethical and professional development of medical students. This study provides support for proposals to limit communication between programs and applicants during the residency selection process.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.