Overview
Aseptic meningitis is a clinical syndrome characterized by meningeal inflammation without evidence of bacterial infection, often induced by medications, vaccines, or viral infections 1356.Diagnosis
Clinical Presentation: Headache, fever, neck stiffness, and altered mental status 13.
Laboratory Tests: Lumbar puncture revealing lymphocytic pleocytosis, normal glucose levels, and elevated protein 13.
Exclusion of Infection: Negative cerebrospinal fluid (CSF) cultures and serologies for common pathogens 13.
Drug History: Detailed medication history to identify potential drug-induced causes 124.Management
Discontinue Triggering Agent: Stop the suspected drug or vaccine if drug-induced 124.
Symptomatic Treatment: Analgesics for headache, hydration, and antipyretics for fever 13.
Supportive Care: Monitor for complications and provide supportive management as needed 13.Special Populations
Pediatrics: High attack rates observed in high school football players, likely due to close contact and viral transmission 56.
Elderly: Increased risk with certain pathogens like Listeria monocytogenes, though specific drug-induced cases less emphasized 4.
Comorbidities: Patients with AIDS may have recurrent episodes linked to prophylactic medications like TMP/SMX 4.Key Recommendations
Suspect Drug-Induced Causes in patients with aseptic meningitis and a negative infectious workup (Evidence: Moderate 1234).
Conduct Thorough Medication Review to identify potential triggers for drug-induced aseptic meningitis (Evidence: Moderate 1234).
Evaluate for Viral Etiologies in outbreaks among specific populations, such as high school athletes, due to person-to-person transmission (Evidence: Moderate 56).References
1 Masago S, Kotake K, Yamaoka K, Yorifuji K, Shimizu T. Drug-induced Aseptic Meningitis: Pharmacovigilance Analysis of Japanese Adverse Event Reporting Database. In vivo (Athens, Greece) 2026. link
2 Ågnes C, Schwartz T, Quist-Paulsen E, Bhatti R, Njaastad AM, Fuglestved J et al.. Drug-induced aseptic meningitis. Tidsskrift for den Norske laegeforening : tidsskrift for praktisk medicin, ny raekke 2023. link
3 Bihan K, Weiss N, Théophile H, Funck-Brentano C, Lebrun-Vignes B. Drug-induced aseptic meningitis: 329 cases from the French pharmacovigilance database analysis. British journal of clinical pharmacology 2019. link
4 Wambulwa C, Bwayo S, Laiyemo AO, Lombardo F. Trimethoprim-sulfamethoxazole-induced aseptic meningitis. Journal of the National Medical Association 2005. link
5 Moore M, Baron RC, Filstein MR, Lofgren JP, Rowley DL, Schonberger LB et al.. Aseptic meningitis and high school football players. 1978 and 1980. JAMA 1983. link
6 Baron RC, Hatch MH, Kleeman K, MacCormack JN. Aseptic meningitis among members of a high school football team. An outbreak associated with echovirus 16 infection. JAMA 1982. link