[Recurrent aseptic meningitis secondary to taking ibuprofen and ketorolac].
BACKGROUND
Aseptic meningitis is a process that is characterised by an inflammatory reaction of the meninges that is not due to any infectious agent. Its aetiology is varied and is most frequently caused by rheumatologic and/or autoimmune processes, chemical or medication-induced meningitis, the most notable drugs involved being antibiotics and non-steroidal anti-inflammatory drugs (NSAI).


METHODS
We report the case of a 70-year-old male, with no relevant history, who was admitted to hospital five times over a period of 16 months because of acute meningitis with polymorphonuclear pleocytosis, high protein levels in cerebrospinal fluid and normal glucose in cerebrospinal fluid. No evidence of an infectious causation, chemical meningitis, carcinomatosis or autoimmune disease was found and the patient was diagnosed with recurrent aseptic meningitis. It was found that the patient had taken ibuprofen or ketorolac on several occasions, a few hours before the appearance of symptoms. These episodes were quickly resolved after withdrawal of this medication.


CONCLUSIONS
A number of NSAI have been reported as inducers of aseptic meningitis, one of the most notable being ibuprofen. We report the case of a patient who, as a consequence of taking ibuprofen and ketorolac, presented episodes of recurrent aseptic meningitis. To our knowledge this side effect of ketorolac has not been reported before. Its clinical features are impossible to differentiate from those of infectious meningitis. Diagnosis is reached by exclusion and a careful pharmacological study, including over-the-counter drugs like some of the NSAI, must be performed in patients with this condition, since it is a problem that can easily be solved by withdrawing the drug that causes it.
Cano Vargas-Machuca
E
E
Servicio de Neurología, Hospital Virgen de la Salud, Toledo, Spain. efcanovm@yahoo.es
Mondéjar-Marín
B
B
Navarro-Muñoz
S
S
Pérez-Molina
I
I
Garrido-Robres
J A
JA
Alvarez-Tejerina
A
A
D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D006801:Humans; D007052:Ibuprofen / Q000009:adverse effects*; D020910:Ketorolac / Q000009:adverse effects*; D008297:Male; D008582:Meningitis, Aseptic / Q000139:chemically induced* / Q000175:diagnosis; D012008:Recurrence
D000894:Anti-Inflammatory Agents, Non-Steroidal; D007052:Ibuprofen; D020910:Ketorolac