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Noninfectious Meningitis

by John E. Greenlee, MD

Meningitis is occasionally caused by noninfectious conditions (eg, noninfectious disorders, drugs, vaccines). Many cases of noninfectious meningitis are subacute or chronic (see Subacute and Chronic Meningitis).

Some Noninfectious Causes of Meningitis

Type

Examples

Disorders

Metastatic cancer

Sarcoidosis

Behçet syndrome

SLE

Sjögren syndrome

RA

Rupture of an intracranial cysticercal or epidermoid cyst

Drugs with anti-inflammatory or immune-modulating effects

Azathioprine

Cyclosporine

Cytosine arabinoside

IVIG

Muromonab-CD3 (OKT3)

NSAIDs (most commonly, ibuprofen)

Other drugs

Certain antibiotics (eg, ciprofloxacin, isoniazid, penicillin, trimethoprim/sulfamethoxazole)

Carbamazepine

Phenazopyridine

Ranitidine

Substances injected into the subarachnoid space

Anesthetics

Antibiotics

Chemotherapy drugs

Radiopaque dyes

Vaccines

Pertussis

Rabies

Smallpox

Noninfectious meningitis causes symptoms (eg, headache, fever, nuchal rigidity) that are similar to those caused by other kinds of meningitis. Severity and acuity can vary, but noninfectious meningitis tends to be less severe than acute bacterial meningitis.

Diagnosis is based on analysis of CSF obtained by lumbar puncture (preceded by neuroimaging if increased intracranial pressure or a mass is suspected—see Lumbar puncture). Findings may include lymphocytic or neutrophilic pleocytosis, elevated protein, and usually normal glucose.

Causative disorders are treated, and causative drugs are stopped. Otherwise, treatment is supportive.

If patients appear serious ill, appropriate antibiotics and corticosteroids are started immediately (without waiting for tests results) and continued until acute bacterial meningitis is ruled out (ie, CSF is shown to be sterile).

Resources In This Article

Drugs Mentioned In This Article

  • Drug Name
    Select Trade
  • ADVIL, MOTRIN IB
  • No US brand name
  • LANIAZID
  • NEORAL, SANDIMMUNE
  • CILOXAN, CIPRO
  • IMURAN
  • ZANTAC
  • TEGRETOL

* This is a professional Version *