Department of Neurology and Neurophysiology, Ziv Medical Center, Safed, Israel.
Int J Gen Med. 2010 Jul 21;3:157-62. doi: 10.2147/ijgm.s11577.
Meningitis is usually produced by an infectious agent, but there are multiple noninfectious causes. Drug-induced aseptic meningitis (DIAM) is an important entity and has been reported as an uncommon adverse reaction with numerous agents. Thus, DIAM constitutes a diagnostic and patient management challenge. We present a patient with three episodes of aseptic meningitis due to amoxicillin, and then review the literature on this rare idiosyncratic event which may occur after local or systemic drug administration. A 77-year-old man was admitted to our hospital with fever, headache, and neck stiffness. Seven days before admission he had a dental and gingival inflammation. He was treated with two oral doses of 500 mg daily of amoxicillin for one week. The seventh day he awoke with the complaints that prompted hospital admittance. Amoxicillin was stopped 1 day before his admission. From his history we knew of two similar episodes: The first episode was after a dental procedure 3 months before this incident. He had received a 1-week course of postprocedure amoxicillin of 500 mg daily and had similar headache, fever, and chills during the entire course of treatment. He wasn't admitted to the hospital, because he stopped taking amoxicillin and he felt spontaneous pain relief after taking symptomatic pain treatment. The second episodes was 6 months after his first admission, he had been admitted to our hospital with the same symptoms. Amoxicillin was stopped and changed with intravenous (IV) ceftriaxone (CTRX) for 10 days due to suspected partial untreated meningitis. The patient improved rapidly within 2 days and was discharged from the hospital. On the basis of these three confirmed episodes of meningitis after recurrent exposure to amoxicillin, with repetitive negative testing for viral, bacterial, and mycobacterial micro-organisms, we diagnosed aseptic meningitis induced by amoxicillin. To our knowledge, this is the seventh well documented publication of such a severe side effect of a commonly used antibiotic.
脑膜炎通常由感染性病原体引起，但也有多种非感染性病因。药物诱导性无菌性脑膜炎（DIAM）是一种重要实体，已报道为数众多的药物会引起这种罕见的不良反应。因此，DIAM 构成了诊断和患者管理的挑战。我们报告了 1 例因阿莫西林引起的 3 次无菌性脑膜炎发作病例，并对这一罕见的药物特应性反应进行了文献复习，这种反应可能在局部或全身用药后发生。1 例 77 岁男性因发热、头痛和颈项强直而入院。入院前 7 天，他有牙科和牙龈炎症，接受了 2 次口服 500mg 阿莫西林，每日 1 次，疗程 1 周。第 7 天，他醒来后出现上述症状而入院。入院前 1 天停用阿莫西林。从他的病史中，我们了解到他有过 2 次类似的发作：第 1 次发作是在此次事件前 3 个月的牙科手术后。他接受了 1 周疗程的术后阿莫西林治疗，剂量为 500mg 每日 1 次，在整个治疗过程中出现类似的头痛、发热和寒战。他没有住院，因为他停止服用阿莫西林，在服用对症止痛药后疼痛自行缓解。第 2 次发作是在第 1 次入院后 6 个月，他因同样的症状再次入院。由于疑似部分未治疗的脑膜炎，停用阿莫西林并改用静脉（IV）头孢曲松（CTRX）治疗 10 天。患者在 2 天内迅速改善并出院。基于这 3 次明确的脑膜炎发作，在反复检测病毒、细菌和分枝杆菌微生物均为阴性后，我们诊断为阿莫西林引起的无菌性脑膜炎。据我们所知，这是第 7 例有文献记录的这种常用抗生素严重副作用的病例。
