Meningitis is occasionally caused by noninfectious conditions (eg, noninfectious disorders, medications, vaccines). Many cases of noninfectious meningitis are subacute or chronic.
(See also Overview of Meningitis.)
Some Noninfectious Causes of Meningitis
Type | Examples |
|---|---|
Disorders | Metastatic cancer Systemic lupus erythematosus (SLE) Rupture of an intracranial cysticercal or epidermoid cyst |
Medications with anti-inflammatory or immune-modulating effects | AzathioprineAzathioprine CyclosporineCyclosporine Cytosine arabinoside IV immune globulin Nonsteroidal anti-inflammatory drugs (most commonly, ibuprofen)Nonsteroidal anti-inflammatory drugs (most commonly, ibuprofen) |
Other medications | Certain antibiotics (eg, ciprofloxacin, isoniazid, penicillin, trimethoprim/sulfamethoxazole) Certain antibiotics (eg, ciprofloxacin, isoniazid, penicillin, trimethoprim/sulfamethoxazole) CarbamazepineCarbamazepine PhenazopyridinePhenazopyridine Ranitidine (unavailable in the United States) |
Substances injected into the subarachnoid space | Anesthetics Antibiotics Chemotherapeutic agents Radiopaque contrast agents |
Symptoms of noninfectious meningitis are similar to those caused by other kinds of meningitis (eg, headache, fever, nuchal rigidity). Severity and acuity can vary, but noninfectious meningitis tends to be less severe than acute bacterial meningitis.
Diagnosis of noninfectious meningitis is based on analysis of cerebrospinal fluid (CSF) obtained by lumbar puncture (preceded by neuroimaging if increased intracranial pressure or an intracranial mass effect is suspected). CSF findings may include
Lymphocytic or neutrophilic pleocytosis
Elevated protein
Usually normal glucose
Noninfectious meningitis can be suspected if microbiologic testing does not detect any evidence of pathogens, particularly in patients with disorders known to cause meningitis (eg, Behçet syndrome, Sjögren syndrome). However, in these patients, infectious meningitis may be caused by atypical or hard-to-culture organisms. Noninfectious meningitis can also be suspected if episodes of meningitis are temporally associated with exposure to a potentially causative medication.
Treatment of noninfectious meningitis involves treating causative disorders and stopping causative medications. Otherwise, treatment is supportive.
If patients appear seriously 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).
