Possible Trimethoprim/Sulfamethoxazole-Induced Aseptic Meningitis

Therrien, Roxane

doi:10.1345/aph.1d581

Cited by 13 publications

(4 citation statements)

References 18 publications

(64 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This may be because autoimmune diseases are more common in women, and it may be that women are also more susceptible to DIAM. 10 Another possibility is that women have significantly more urinary tract infections than men, and TMP-SMX is the first line of treatment. 11 DIAM is more likely to occur in patients with autoimmune conditions, mainly SLE.…”

Section: Discussionmentioning

confidence: 99%

Clinical Characteristics, Diagnosis, and Management of Aseptic Meningitis Induced by Trimethoprim-Sulfamethoxazole

Fan,

He,

Sun

et al. 2023

IDR

View full text Add to dashboard Cite

Objective: Trimethoprim sulfamethoxazole (TMP-SMX) is related to aseptic meningitis. However, a detailed description of its phenotype is lacking, which easily leads to misdiagnosis. The purpose of this article is to explore the clinical characteristics of TMP-SMX-induced aseptic meningitis (TSIAM). Methods: We collected literature related to TSIAM published before July 31, 2023, by searching Chinese and English databases. Data were extracted and analyzed descriptively. Results: The 55 patients were mostly female (60.0%), with a median age of 43 years (range: 2.5-90 years). The first onset time was from a few minutes to 3 months after administration, and the time of reonset was within 12 hours. Fever (98.2%), headache (78.2%), altered mental status (42.3%), nausea and vomiting (41.8%), and neck pain (34.5%) were the most common symptoms. In severe cases, patients presented with low blood pressure, seizures, unconsciousness, or coma. Typical cerebrospinal fluid analysis showed elevated white blood cell counts, with polymorphonuclear leukocytes predominating, elevated protein levels, and normal glucose levels. Brain imaging usually showed no abnormalities. Symptoms resolved rapidly after the discontinuation of TMP-SMX, within a median time of 2 days (range: 1, 60). Readministration of TMP-SMX led to another relapse of aseptic meningitis. Aseptic meningitis usually culminated in a full recovery, although one patient experienced permanent paraplegia. Conclusion: Clinicians should be aware that aseptic meningitis is a rare adverse effect of TMP-SMX. TMP-SMX should be discontinued in patients with TSIAM to reduce unnecessary testing and treatment, and readministration of TMP-SMX should be avoided.

show abstract

Section: Discussionmentioning

confidence: 99%

Clinical Characteristics, Diagnosis, and Management of Aseptic Meningitis Induced by Trimethoprim-Sulfamethoxazole

Fan,

He,

Sun

et al. 2023

IDR

View full text Add to dashboard Cite

show abstract

“…The interval between the onset of symptoms varies, from minutes to months post-ingestion of the offending agent. 2,3 The literature suggests that NSAIDs are frequently the culprit in DIAM. 3 In relation to other drug classes, beta-lactams and trimethoprim-containing antibiotics have been frequently reported as a cause.…”

Section: Discussionmentioning

confidence: 99%

“…1,2 Antibiotics may cause immune complex reaction. 2,3,7 In co-trimoxazole-induced aseptic meningitis, immune complexes have been found in plasma but not in CSF. Some authors suggest that immune complex deposition on the choroid plexus causes necrotising vasculitis of small vessels, resulting in meningitis.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

A diagnostic dilemma: drug-induced aseptic meningitis in a 45-year-old HIV-positive man

et al. 2013

View full text Add to dashboard Cite

We describe a case of aseptic meningitis following the administration of moxifloxacin in a 45-year-old man with human immunodeficiency virus (HIV). At presentation he was receiving tuberculosis treatment on a modified regimen following severe hepatotoxicity; this included moxifloxacin, started 8 days previously. Initial cerebrospinal fluid (CSF) analysis was grossly abnormal. Anti-viral and -bacterial treatments were started. All microbiological tests proved negative and his moxifloxacin was withheld resulting in a complete normalisation of CSF. Drug-induced aseptic meningitis is a diagnosis of exclusion and presents a serious diagnostic dilemma. The decision to withhold medication cannot be taken lightly.

show abstract

Current awareness: Pharmacoepidemiology and drug safety

2005

Pharmacoepidem. Drug Safe.

View full text Add to dashboard Cite

In order to keep subscribers up‐to‐date with the latest developments in their field, John Wiley & Sons are providing a current awareness service in each issue of the journal. The bibliography contains newly published material in the field of pharmacoepidemiology and drug safety. Each bibliography is divided into 20 sections: 1 Books, Reviews & Symposia; 2 General; 3 Anti‐infective Agents; 4 Cardiovascular System Agents; 5 CNS Depressive Agents; 6 Non‐steroidal Anti‐inflammatory Agents; 7 CNS Agents; 8 Anti‐neoplastic Agents; 9 Haematological Agents; 10 Neuroregulator‐Blocking Agents; 11 Dermatological Agents; 12 Immunosuppressive Agents; 13 Autonomic Agents; 14 Respiratory System Agents; 15 Neuromuscular Agents; 16 Reproductive System Agents; 17 Gastrointestinal System Agents; 18 Anti‐inflammatory Agents ‐ Steroidal; 19 Teratogens/fetal exposure; 20 Others. Within each section, articles are listed in alphabetical order with respect to author. If, in the preceding period, no publications are located relevant to any one of these headings, that section will be omitted.

show abstract

Possible Trimethoprim/Sulfamethoxazole-Induced Aseptic Meningitis

Abstract: Despite the widespread use of TMP/SMX and the years of experience we have had with the drug, it is important to remain vigilant regarding possible adverse effects, particularly aseptic meningitis.

Cited by 13 publications

References 18 publications

Clinical Characteristics, Diagnosis, and Management of Aseptic Meningitis Induced by Trimethoprim-Sulfamethoxazole

Clinical Characteristics, Diagnosis, and Management of Aseptic Meningitis Induced by Trimethoprim-Sulfamethoxazole

A diagnostic dilemma: drug-induced aseptic meningitis in a 45-year-old HIV-positive man

Current awareness: Pharmacoepidemiology and drug safety

Contact Info

Product

Resources

About