Drug-Induced Aseptic Meningitis and Central Nervous System Effects

Drug-induced aseptic meningitis is an inflammatory syndrome of the meninges arising as an adverse reaction to a variety of pharmacological agents rather than an infectious pathogen. The clinical presentation often mimics bacterial or viral meningitis, with headache, fever, neck stiffness and photophobia. Cerebrospinal fluid analysis typically reveals pleocytosis—most often lymphocytic—with elevated protein and normal glucose levels, while cultures remain sterile. Pathophysiological mechanisms include hypersensitivity reactions, direct chemical irritation and immune complex deposition within the meningeal vasculature. Nonsteroidal anti-inflammatory drugs (NSAIDs), antibiotics such as β-lactams and sulfonamides, intravenous immunoglobulins and intrathecal analgesics have all been implicated. Diagnosis rests on a high index of suspicion, thorough medication history, exclusion of infectious and neoplastic causes and resolution of symptoms upon drug withdrawal. Recent advances have emphasised the role of immunomodulatory pathways and blood–brain barrier integrity in mediating central nervous system toxicity. Recognition of this condition is crucial to prevent unnecessary antimicrobial therapy, reduce hospital stays and guide safer prescribing practices globally.

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Drug-Induced Aseptic Meningitis and Central Nervous System Effects publication trend

The graph below shows the total number of articles in drug-induced aseptic meningitis and central nervous system effects across all publications each year (not limited to Nature Index journals).

Technical terms

Aseptic meningitis: Inflammation of the meninges not attributable to bacterial or viral infection, often resulting from drugs or immune-mediated processes.

Cerebrospinal fluid (CSF): The clear fluid surrounding the brain and spinal cord, analysed to assess cell counts, protein, glucose and the presence of pathogens or inflammatory markers.

Pleocytosis: An elevated white blood cell count in CSF, typically reflecting immune activation within the central nervous system.

Hypersensitivity reaction: An exaggerated immune response to a substance, which may involve antibody or T-cell mediators leading to tissue inflammation.

Meningeal enhancement: Increased contrast uptake by the meninges on magnetic resonance imaging, indicating inflammation of the meningeal layers.

References

1. Amoxicillin-induced aseptic meningitis: clinical features, diagnosis and management. European Journal of Medical Research (2023).
2. Elderly Woman With No Autoimmune Disease With Aseptic Meningitis Caused by Celecoxib. Cureus (2024).
3. Chemical‐induced aseptic meningitis as a result of intrathecal hydromorphone therapy: Case report. Clinical Case Reports (2021).
4. Trimethoprim-sulfamethoxazole induced aseptic meningitis case report. Medicine (2023).