Carbamazepine-Induced Aseptic Meningitis

Simon, Lynn T.; Hsu, Benjamin; Adornato, Bruce T.

doi:10.7326/0003-4819-112-8-627

Cited by 19 publications

(4 citation statements)

References 8 publications

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“…Four patients have been described who developed meningitis after carbamazepine therapy, one of them with Sjö gren syndrome and trigeminal neuralgia, 2 with manic depressive syndrome and another with isolated trigeminal neuralgia. [148][149][150][151] The clinical case was indistinguishable from other DIAM, although 1 patient had myoclonus with normal carbamazepine levels. 149 There was peripheral eosinophilia (30% of total white blood cell count) in 2 of them 148,150 and 2% eosinophils in the CSF in 1.…”

Section: Other Agents Associated With Diammentioning

confidence: 99%

“…[148][149][150][151] The clinical case was indistinguishable from other DIAM, although 1 patient had myoclonus with normal carbamazepine levels. 149 There was peripheral eosinophilia (30% of total white blood cell count) in 2 of them 148,150 and 2% eosinophils in the CSF in 1. 150 As noted by Quinn and colleagues, 8 counting CSF eosinophils is challenging because of technical difficulties, inexperience of the examiner, and the fragility of this cell.…”

Section: Other Agents Associated With Diammentioning

confidence: 99%

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The Challenge of Drug-Induced Aseptic Meningitis

Morís¹,

1999

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Several drugs can induce the development of aseptic meningitis. Drug-induced aseptic meningitis (DIAM) can mimic an infectious process as well as meningitides that are secondary to systemic disorders for which these drugs are used. Thus, DIAM constitutes a diagnostic and patient management challenge. Cases of DIAM were reviewed through a MEDLINE literature search (up to June 1998) to identify possible clinical and laboratory characteristics that would be helpful in distinguishing DIAM from other forms of meningitis or in identifying a specific drug as the culprit of DIAM. Our review showed that nonsteroidal anti-inflammatory drugs (NSAIDs), antibiotics, intravenous immunoglobulins, and OKT3 antibodies (monoclonal antibodies against the T3 receptor) are the most frequent cause of DIAM. Resolution occurs several days after drug discontinuation and the clinical and cerebrospinal fluid profile (neutrophilic pleocytosis) do not allow DIAM to be distinguished from infectious meningitis. Nor are there any specific characteristics associated with a specific drug. Systemic lupus erythematosus seems to predispose to NSAID-related meningitis. We conclude that a thorough history on prior drug intake must be conducted in every case of meningitis, with special focus on those aforementioned drugs. If there is a suspicion of DIAM, a third-generation cephalosporin seems a reasonable treatment option until cerebrospinal fluid cultures are available.

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Section: Other Agents Associated With Diammentioning

confidence: 99%

Section: Other Agents Associated With Diammentioning

confidence: 99%

The Challenge of Drug-Induced Aseptic Meningitis

Morís¹,

1999

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“…Importantly, resolution of symptoms occurred several days after carbamazepine was discontinued. [17][18][19][20] In two of the cases, the patients were rechallenged with carbamazepine, only to see a recurrence of symptoms, with resolution after stopping treatment a second time. 17,18 No information on Naranjo scale scoring was provided in these reports.…”

Section: ■ Discussionmentioning

confidence: 99%

“…8 The mainstay of treatment for DIAM (including AEIM) is discontinuation of the offending agent. 2,8,[11][12][13][14][15][17][18][19][20] Recovery after drug discontinuation is common in documented cases of AEIM, with resolution of symptoms typically occurring within 2 to 3 days of drug discontinuation. Bacterial meningitis may be suspected in the time before AEIM is fi nally diagnosed, and third-generation cephalosporins are typically the antibiotics given in this situation; a short course of therapy can be used until CSF parameters normalize.…”

Section: ■ Discussionmentioning

confidence: 99%