Drug- and chemical-induced aseptic meningitis: a review of the literature.
OBJECTIVE
The primary objective of this article is to provide readers with case reports of drug- or chemical-induced aseptic meningitis (DCAM) described in the medical literature. Background information regarding the classification of DCAM, incidence, proposed mechanisms, associated risk factors, clinical management, and sequelae is presented.


METHODS
A MEDLINE search was used to identify pertinent background literature and case reports of DCAM.


METHODS
All case reports of DCAM involve anecdotal information. A critical analysis of a causal relationship to the implicated drug or chemical and the appearance of meningeal involvement is presented. Animal data are included when pertinent.


RESULTS
DCAM is a rare adverse event associated with numerous agents. Patients present with a variety of clinical signs and symptoms and laboratory findings of cerebral spinal fluid, when obtained, vary greatly. Most patients fully recover without sequelae.


CONCLUSIONS
Numerous drugs and chemicals have been implicated in the medical literature as producing DCAM. Two proposed mechanisms of DCAM have been theorized: a delayed hypersensitivity-type reaction and direct meningeal irritation. The nonsteroidal antiinflammatory drugs, certain antibiotics, radiographic agents, and muromonab-CD3 have been most frequently implicated. There appears to be an association between the occurrence of the hypersensitivity-type reactions and underlying collagen vascular or rheumatologic disease.
Marinac
J S
JS
Department of Medicine, School of Medicine, University of Missouri-Kansas City.
D000890:Anti-Infective Agents / Q000009:adverse effects; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects; D004342:Drug Hypersensitivity / Q000150:complications; D006801:Humans; D006968:Hypersensitivity, Delayed / Q000150:complications; D008180:Lupus Erythematosus, Systemic / Q000150:complications; D008582:Meningitis, Aseptic / Q000134:cerebrospinal fluid / Q000139:chemically induced* / Q000175:diagnosis; D012008:Recurrence; D012307:Risk Factors
D000890:Anti-Infective Agents; D000894:Anti-Inflammatory Agents, Non-Steroidal