Pathogenesis and predisposing factors in drug-induced aseptic meningitis: A case study

Abstract

Case PresentationA 61-year-old European man was admitted with two days of progressive high-grade fevers, neck stiffness, and headache. He started taking ibuprofen 400 mg three times a day for an ankle sprain 24 hours prior to his symptoms. He was screened for genitourinary, gastro-intestinal, and cardiorespiratory causes for his symptoms, which were negative.Collateral history revealed previous admissions with meningitis but suggested his current presentation was more severe than the previous admissions in 2012 and 2016, neither of which yielded identifiable pathogens on lumbar puncture, despite showing neutrophilic pleocytosis. He had also taken non-steroidal anti-inflammatories (NSAIDs) prior to those admissions.The patient had no other significant medical history and took no regular medications. He was a non-drinker, an ex-smoker (5 packyears), and normally independent in his activities of daily living.On examination, the patient was tremulous and flushed. His temperature was 38.2 o C. Kernig's and Brudzinski's signs were positive, and he complained of moderate photophobia in a well-lit room. No focal neurological signs were noted, and apart from his ankle, all systems examinations were unremarkable.Blood tests revealed mildly elevated inflammatory changes (C-reactive protein 8 mg/L and white cell count (WCC) 15.1x10 3 /µL). Liver, thyroid, and renal function tests were normal, as were electrolytes, B12, folate, creatine kinase, and lipase. Blood cultures, human immunodeficiency virus (HIV), and Treponemal serology were negative. Head imaging with computed tomography (CT) and magnetic resonance imaging (MRI) was normal, and a lumbar puncture showed a neutrophilic pleocytosis (WCC 67x10 6 /L; 54% neutrophils) with raised protein (820 mg/L) and normal glucose (2.8 mmol/L). Cerebrospinal fluid (CSF) cultures were sterile, and a polymerase chain reaction (PCR) panel was negative for herpes simplex virus 1 and 2, varicella zoster virus, Neisseria meningitidis, Streptococcus pneumoniae, Haemophilus influenzae, and enterovirus. There were no other sources of infection found through either a CT chest or echocardiogram.

Decoding a Doctor’s Prescription: A Study

“…They are usually connected with reliable knowledge. According to Ghosh and Ghosh (2010), pharmaceutical companies can play an important role in drug promotions and marketing initiatives, which can in turn affect prescriptions by doctors. Ghosh et al state that different drug promotions include sponsoring continuous medical programs and conferences that could get doctors to prescribe a brand.…”

“…If the medical representative does not have patience or wastes the time of the doctor unnecessarily, then his products will not be prescribed. In contrast, if the doctor asks the medical representative a question and he does not know the answer but promises to get back to him and does so, then he will be appreciated by the doctor (Ghosh & Ghosh, 2010).…”