Possible trimethoprim/sulfamethoxazole-induced aseptic meningitis.
OBJECTIVE
To report a case of trimethoprim/sulfamethoxazole (TMP/SMX)-induced aseptic meningitis.


METHODS
An 18-year-old woman diagnosed with acute myeloid leukemia was admitted for a bone marrow transplant. She had already attained remission with daunorubicin, thioguanine, and high-dose cytarabine. A routine lumbar puncture performed on admission revealed an abnormally elevated leukocyte count, and meningitis was suspected. The patient had been taking TMP/SMX (trimethoprim 120 mg) twice daily on Monday, Tuesday, and Wednesday for the past 3 months; no other medication was being used. Upon examination, the patient mentioned having had headaches for the past few weeks. Since viral, bacterial, and fungal cultures were negative, a diagnosis of aseptic meningitis was made. According to the Naranjo probability scale, TMP/SMX was a possible cause of the aseptic meningitis. Eleven days after discontinuation of TMP/SMX, lumbar puncture results had returned to normal.


CONCLUSIONS
Many drugs have been associated with aseptic meningitis. Antibiotics are often linked with aseptic meningitis, with TMP/SMX being the most frequently associated antibiotic. Many cases of TMP/SMX-induced aseptic meningitis have been reported, while few cases have been reported with trimethoprim and sulfamethoxazole given separately.


CONCLUSIONS
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.
Therrien
Roxane
R
Pharmacy Department, Centre Universitaire Mère-Enfant Ste-Justine, 3175 Côte Ste-Catherine, Montréal, Quebec H3T 1C5, Canada. therrien.hsj@ssss.gouv.qc.ca
D000293:Adolescent; D000890:Anti-Infective Agents / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008582:Meningitis, Aseptic / Q000139:chemically induced*; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000009:adverse effects*
D000890:Anti-Infective Agents; D015662:Trimethoprim, Sulfamethoxazole Drug Combination