Diferencia entre revisiones de «Drug induced aseptic meningitis»
Sin resumen de edición |
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| (No se muestran 2 ediciones intermedias del mismo usuario) | |||
| Línea 10: | Línea 10: | ||
**Most common cause | **Most common cause | ||
*[[Antibiotics]] | *[[Antibiotics]] | ||
** | **Sulfamethizole | ||
**[[TMP-SMX]] | **[[TMP-SMX]] | ||
**[[Isoniazid]] | **[[Isoniazid]] | ||
| Línea 24: | Línea 24: | ||
**OKT3 monoclonal antibodies | **OKT3 monoclonal antibodies | ||
*Misc | *Misc | ||
** | **Sulfasalazine | ||
**[[Carbamazepine]] | **[[Carbamazepine]] | ||
**[[Azathioprine]] | **[[Azathioprine]] | ||
| Línea 31: | Línea 31: | ||
**[[Ranitidine]] | **[[Ranitidine]] | ||
**[[Famotidine]] | **[[Famotidine]] | ||
** | **Methylprednisolone acetate | ||
**[[Allopurinol]] | **[[Allopurinol]] | ||
==Clinical Freatures== | ==Clinical Freatures== | ||
''Symptoms generally occur within 24-48 hours after taking drug'' | |||
*[[Headache]] | *[[Headache]] | ||
*[[Fever]] | *[[Fever]] | ||
| Línea 62: | Línea 63: | ||
==Disposition== | ==Disposition== | ||
==Outcome== | |||
*Generally good, usually with no long term sequelae | |||
Revisión actual - 16:21 12 sep 2017
Background
- Abbreviation: DIAM
- Two proposed mechanisms
- Direct meningeal irritation by intrathecal drug
- Hypersensitivity reaction to drug (type III and IV)
- Higher predominance in SLE and female gender
Causes
- NSAIDs
- Most common cause
- Antibiotics
- Immunoregulating agents
- IVIGs
- OKT3 monoclonal antibodies
- Misc
- Sulfasalazine
- Carbamazepine
- Azathioprine
- Indinavir
- Valacyclovir
- Ranitidine
- Famotidine
- Methylprednisolone acetate
- Allopurinol
Clinical Freatures
Symptoms generally occur within 24-48 hours after taking drug
- Headache
- Fever
- Nuchal rigidity
- Nausea/vomiting
- General malaise
- Altered mental status
- Less common symptoms include rash, arthralgia, myalgia, facial edema
Differential Diagnosis
Headache
Common
Killers
- Meningitis/encephalitis
- Myocardial ischemia
- Retropharyngeal abscess
- Intracranial Hemorrhage (ICH)
- SAH / sentinel bleed
- Acute obstructive hydrocephalus
- Space occupying lesions
- CVA
- Carbon monoxide poisoning
- Basilar artery dissection
- Preeclampsia
- Cerebral venous thrombosis
- Hypertensive emergency
- Depression
Maimers
- Giant cell arteritis of temporal artery (temporal arteritis)
- Idiopathic intracranial hypertension (Pseudotumor Cerebri)
- Acute Glaucoma
- Acute sinusitis
- Cavernous sinus thrombosis or cerebral sinus thrombosis
- Carotid artery dissection
Others
- Mild traumatic brain injury
- Trigeminal neuralgia
- TMJ pain
- Post-lumbar puncture headache
- Dehydration
- Analgesia abuse
- Various ocular and dental problems
- Herpes zoster ophthalmicus
- Herpes zoster oticus
- Cryptococcosis
- Febrile headache (e.g. pyelonephritis, nonspecific viral infection)
- Ophthalmoplegic migraine
- Superior Vena Cava Syndrome
Aseptic Meningitis
- Viral
- Tuberculosis
- Lyme disease
- Syphilis
- Leptospirosis
- Fungal (AIDS, transplant, chemotherapy, chronic steroid use)
- Noninfectious
Evaluation
- Drug history with focus on time of ingestion and symptom onset
- CSF studies
- Pleiocytosis (primarily neutrophilic)
- Elevated protein levels
- Normal glucose
- Negative cultures
- Challenge test with suspected drug
- Only confirmatory test
- Requires informed written consent
- Due to associated risk, should only be done if suspected drug is irreplaceable
Management
- Discontinuation of offending agent
Disposition
Outcome
- Generally good, usually with no long term sequelae