Drug- and Chemical-Induced Aseptic Meningitis: A Review of the Literature

1992 ◽  
Vol 26 (6) ◽  
pp. 813-822 ◽  
Author(s):  
Jacqueline S. Marinac
Keyword(s):  
Aseptic Meningitis ◽  
Medical Literature ◽  
Case Reports ◽  
Clinical Signs ◽  
Primary Objective ◽  
Background Information ◽  
Antiinflammatory Drugs ◽  
Laboratory Findings ◽  
Medline Search ◽  
Meningeal Involvement

OBJECTIVE: The primary objective of this article is to provide readers with case reports of drug- or chemical-induced aseptic meningitis (DCAM) described in the medical literature. Background information regarding the classification of DCAM, incidence, proposed mechanisms, associated risk factors, clinical management, and sequelae is presented. DATA SOURCES: A MEDLINE search was used to identify pertinent background literature and case reports of DCAM. DATA EXTRACTION: All case reports of DCAM involve anecdotal information. A critical analysis of a causal relationship to the implicated drug or chemical and the appearance of meningeal involvement is presented. Animal data are included when pertinent. DATA SYNTHESIS: DCAM is a rare adverse event associated with numerous agents. Patients present with a variety of clinical signs and symptoms and laboratory findings of cerebral spinal fluid, when obtained, vary greatly. Most patients fully recover without sequelae. CONCLUSIONS: Numerous drugs and chemicals have been implicated in the medical literature as producing DCAM. Two proposed mechanisms of DCAM have been theorized: a delayed hypersensitivity-type reaction and direct meningeal irritation. The nonsteroidal antiinflammatory drugs, certain antibiotics, radiographic agents, and muromonab-CD3 have been most frequently implicated. There appears to be an association between the occurrence of the hypersensitivity-type reactions and underlying collagen vascular or rheumatologic disease.

Beyond Benzodiazepines: Alternative Pharmacologic Agents for the Treatment of Insomnia

1998 ◽  
Vol 32 (6) ◽  
pp. 680-691 ◽  
Author(s):  
Judy Wagner ◽  
Mary L Wagner ◽  
Wayne A Hening
Keyword(s):  
Clinical Trials ◽  
Case Reports ◽  
Data Extraction ◽  
Benzodiazepine Receptor ◽  
Background Information ◽  
Comparable Efficacy ◽  
Pharmacologic Therapy ◽  
Safety And Efficacy ◽  
Medline Search ◽  
Review Articles

OBJECTIVE: To review the epidemiology, etiology, and classification of insomnia and provide an overview of the pharmacologic therapy of insomnia. Novel nonbenzodiazepine hypnotics including zolpidem, zopiclone, and zaleplon, as well as nonprescription products such as valerian and melatonin, are reviewed in detail. DATA SOURCES: A MEDLINE search was performed to identify relevant clinical studies, case reports, abstracts, and review articles published between April 1992 and December 1997. Key search terms included insomnia, benzodiazepines, zolpidem, zopiclone, zaleplon, Cl 284,846, melatonin, and valerian. Additional references were obtained from the lists of review articles and textbooks. DATA EXTRACTION AND SYNTHESIS: Data concerning the safety and efficacy of the hypnotic agents were extracted from all available clinical trials and abstracts. Background information regarding insomnia, benzodiazepines, and other hypnotics was extracted from the most current literature, including review articles and textbooks. CONCLUSIONS: New developments in benzodiazepine receptor pharmacology have introduced novel nonbenzodiazepine hypnotics that provide comparable efficacy to benzodiazepines. Although they may possess theoretical advantages over benzodiazepines based on their unique pharmacologic profiles, they offer few, if any, significant advantages in terms of adverse effects. Over-the-counter agents such as valerian and melatonin may be useful in alleviating mild, short-term insomnia, but further clinical trials are required to fully evaluate their safety and efficacy.

Ibuprofen-Induced Aseptic Meningitis in Rheumatoid Arthritis

1997 ◽  
Vol 31 (9) ◽  
pp. 1009-1011 ◽  
Author(s):  
Amy C Horn ◽  
Steven W Jarrett
Keyword(s):  
Rheumatoid Arthritis ◽  
Systemic Lupus Erythematosus ◽  
Aseptic Meningitis ◽  
Lupus Erythematosus ◽  
Nonsteroidal Antiinflammatory Drugs ◽  
Systemic Lupus ◽  
Antiinflammatory Drugs ◽  
Stiff Neck ◽  
Laboratory Findings ◽  
Increased Risk

Objective To report a case of aseptic meningitis related to ibuprofen ingestion. Case Summary We discuss the case of a 56-year-old white man with a history of rheumatoid arthritis and hypertension who became confused, nauseated, and began to vomit within 2 hours of the ingestion of ibuprofen. A diagnosis of ibuprofen-induced aseptic meningitis was made based on the patient's physical and laboratory findings, the quick onset and resolution of symptoms, and his medical history. Discussion Ibuprofen-induced aseptic meningitis has been most frequently reported in patients with systemic lupus erythematosus. However, there have been reports of this reaction in patients with other underlying disease states. Various nonsteroidal antiinflammatory drugs have been reported to cause this reaction, but ibuprofen is the most common offending agent. A drug-related cause should be considered in any patient who presents with typical meningitis symptoms, such as fever, headache, and stiff neck, that occur within hours of ingesting a drug. Conclusions Although persons with systemic lupus erythematosus appear to have an increased risk for this type of reaction, the development of signs and symptoms in other patients warrants the consideration of nonsteroidal antiinflammatory drugs as the cause of aseptic meningitis.

Anaplasma phagocytophilum in domestic cats from Germany, Austria and Switzerland and clinical/laboratory findings in 18 PCR-positive cats (2008–2020)

2021 ◽  
pp. 1098612X2110174
Author(s):  
Ingo Schäfer ◽  
Barbara Kohn ◽  
Elisabeth Müller
Keyword(s):  
Anaplasma Phagocytophilum ◽  
Clinical Laboratory ◽  
Case Reports ◽  
Clinical Signs ◽  
Indirect Detection ◽  
Detection Methods ◽  
Direct Pcr ◽  
Laboratory Findings ◽  
Additional Information ◽  
Granulocytic Anaplasmosis

Objectives Anaplasma phagocytophilum is considered the most significant rickettsial pathogen affecting cats. The organism is transmitted by ticks of the species Ixodes ricinus in Central Europe and can cause granulocytic anaplasmosis in pets, wildlife and humans. The aims of this study were to assess the frequency of positive test results for A phagocytophilum in cats in Germany, Austria and Switzerland, as well as to evaluate clinical and laboratory findings in cats with positive PCR results. Methods This study included the results of direct (PCR) and indirect detection methods (immunofluorescence antibody tests [IFAT]) requested by veterinarians in Germany, Austria and Switzerland between 2008 and 2020 from the LABOKLIN laboratory (Bad Kissingen, Germany). The veterinarians treating the PCR-positive cats were contacted by telephone to enquire about their clinical signs, laboratory findings, management and outcomes. Results In total, 244/1636 cats (15%) tested positive by direct (PCR: n = 27/725 [4%]) and/or indirect detection methods (IFAT: n = 221/956 [23%]). In 18/26 cats with PCR results positive for A phagocytophilum, additional information about clinical signs, laboratory findings, treatment and outcome was obtained. Of these 18 cats, five had comorbidities independent of their infection with A phagocytophilum. The most common clinical signs in PCR-positive cats (total/without comorbidities) were lethargy (83%/92%), fever (83%/85%) and thrombocytopenia (61%/62%). Overall, more than half (57%) of the cats with and without comorbidities recovered clinically. Conclusions and relevance Infections with A phagocytophilum should be considered as differential diagnoses in cats with tick infestation, lethargy, fever and thrombocytopenia. The clinical signs and laboratory findings are consistent with published case reports in cats. Ectoparasite prophylaxis in cats is recommended throughout the entire year.

scholarly journals An unusual course of COVID-19 infection with late increase in C-reactive protein (clinical case reports)

2020 ◽  
Vol 30 (5) ◽  
pp. 709-714
Author(s):  
S. Yu. Chikina ◽  
M. Yu. Brovko ◽  
V. V. Royuk ◽  
S. N. Avdeev
Keyword(s):  
Comprehensive Evaluation ◽  
Case Reports ◽  
Severe Disease ◽  
Clinical Status ◽  
Clinical Signs ◽  
Common Finding ◽  
C Reactive Protein ◽  
Laboratory Findings ◽  
Antiinflammatory Therapy ◽  
Reactive Protein

Clinical signs of COVID-19 infection are non-specific and diagnosis is typically based on comprehensive evaluation of the patient’s history, clinical status, radiological and laboratory findings. A common finding in COVID-19 patients is increased C-reactive protein (CRP), though in some patients, CRP remains within normal range notwithstanding the presence of other criteria of severe disease. We describe two clinical cases of COVID-19 with severe bilateral pneumonia and late increase in CRP. Similar cases re quite challenging for making the diagnosis and indicating the antiinflammatory therapy.

scholarly journals Feline Hypertrophic Osteopathy Associated with Congenital Megaesophagus: Two Case Reports and Literature Review

2020 ◽  
Vol 71 (3) ◽  
pp. 2413
Author(s):  
A.M. ABU-SEIDA ◽  
F.A. TORAD ◽  
E.A. HASSAN ◽  
K.M. ALI
Keyword(s):  
Differential Diagnosis ◽  
Physical Examination ◽  
Case Reports ◽  
Clinical Signs ◽  
Appendicular Skeleton ◽  
Long Bones ◽  
New Bone Formation ◽  
Thoracic Radiography ◽  
Laboratory Findings ◽  
Laboratory Investigations

This report describes two cases of feline hypertrophic osteopathy (HO) associated with congenital megaesophagus (ME). The diagnosis was based upon case history, physical examination, radiography and laboratory investigations. The clinical signs of both cats included; regurgitation, weakness and reluctance to walk since birth. Physical examination revealed painful and thickened long bones, swollen joints, difficult flexion of all four limbs and normal urination, defecation, appetite as well as heart and respiratory rates. The abnormal laboratory findings were thrombocytosis, leukocytosis with lymphocytosis and monocytosis. Survey and contrast thoracic radiography showed generalizedesophageal dilatation. Radiography of appendicular skeleton revealed symmetrical and massive subperiosteal new bone formation of the affected long bones and pelvis. In conclusion, radiography of extremities is highly recommended for cats admitted with congenital ME and lameness to investigate the possibility of HO. Moreover, the HO should be listed duringthe differential diagnosis of thickened limbs in cats.

scholarly journals Canine copper-associated hepatitis: A retrospective study of 17 clinical cases

2020 ◽  
Vol 10 (2) ◽  
Author(s):  
Anthony Rodrigues ◽  
Rodolfo O. Leal ◽  
Maud Girod ◽  
Claire Dally ◽  
Emmanuel Guery ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Liver Biopsy ◽  
Medical Records ◽  
Case Reports ◽  
Clinical Signs ◽  
Copper Metabolism ◽  
Copper Accumulation ◽  
Hepatic Tissue ◽  
German Shepherd ◽  
Laboratory Findings

Background: Copper-associated hepatitis (CAH) is a well-documented chronic hepatic disease in dogs. In some breeds, the disease results from an inherited defect in copper metabolism. In others, it is unclear whether its acummulation is a primary or secondary condition. Reports of copper accumulation in dog breeds that are not genetically predisposed are increasing.Aim: To describe the epidemiology, clinical and laboratory findings, liver biopsy techniques, and treatment response in dogs with CAH.Methods: A retrospective study was performed, drawing upon medical records from CAH dogs at a Veterinary Referral Hospital in Paris, France. The diagnosis of CAH had been confirmed in these patients by positive rhodanine staining of hepatic tissue obtained through biopsy. Medical records were mined for the following data: age at presentation, sex, breed, chief presenting complaints, abdominal ultrasound (US) findings, and rhodanine staining pattern.Results: A total of 17 dogs were included in the study. Median age at presentation was 8-year old (4–11). No sex predisposition was found. Terriers (4/17) and German Shepherd Dogs (GSD, 3/17) were overrepresented. American Staffordshire Terriers and Beauceron had not previously appeared in case reports on CAH; two of each breed were identified in this study. Clinical signs of affected dogs were non-specific. An incidental identification of increased liverenzymes was observed in 5/17 dogs. A heterogeneous, mottled liver was frequently described (5/17) on abdominal US. Liver biopsies were performed by US-guided percutaneous approach in 10/17 dogs, laparoscopy and laparotomy in 6/17 and 1/17, respectively. The rhodanine staining pattern was centrilobular (zone 3) in 8/17 dogs and periportal (zone 1) in 3/17 dogs. The pattern was considered multifocal in 6/17 dogs.Conclusion: Increased liver enzymes may be the only clinical finding in dogs with copper-associated hepatitis, reflecting the silent progression of this disease. Centrilobular pattern of rhodanine staining was observed in the majority of cases suggesting the primary condition of the disease. Results of this study are consistent with the current literature, which reports that terriers and GSD are predisposed to CAH. This is the first  description of CAH in Beauceron and American Staffordshire Terrier dogs. Keywords: American Staffordshire Terrier, Beauceron, Copper-associated hepatitis, Liver biopsy, Rhodanine.

Adverse Reactions to Human Serum Albumin

1993 ◽  
Vol 27 (1) ◽  
pp. 87-94 ◽  
Author(s):  
Barry J. Gales ◽  
Brian L. Erstad
Keyword(s):  
Human Serum Albumin ◽  
Adverse Effects ◽  
Serum Albumin ◽  
Human Serum ◽  
Case Reports ◽  
Data Extraction ◽  
Primary Objective ◽  
Human Studies ◽  
Hypersensitivity Reactions ◽  
Medline Search

OBJECTIVE: To describe the adverse effects associated with human serum albumin (HSA) administration. DATA SOURCES: A MEDLINE search and bibliography scanning were used to identify pertinent review articles, clinical studies, and case reports. STUDY SELECTION: Emphasis was placed on reporting the results of human studies with the primary objective of investigating adverse effects attributable to HSA administration. Clinical trials that reported the occurrence of adverse effects possibly associated with HSA were also reviewed. Animal data were included where pertinent. DATA EXTRACTION: Although isolated case reports were reviewed, data were primarily extracted from human studies involving large series of patients or studies that were randomized and prospective in nature. DATA SYNTHESIS: Alterations in coagulation, renal, cardiovascular, and pulmonary functions were identified as potential adverse effects following the administration of HSA. Occurrences of hypersensitivity reactions, trace metal loading, and serum amino acid alterations associated with these infusions were also noted and are described here. Pulmonary and cardiovascular systems appear to be particularly prone to complications from excessive HSA administration. Adverse effects such as HSA-induced hypersensitivity reactions may be severe, but occur infrequently. CONCLUSIONS: Controlled studies involving large numbers of patients are not currently available for an accurate assessment of the incidence of adverse effects attributable to HSA administration. Many of the reported reactions appear to be extensions of albumin's pharmacologic activities and would be expected to worsen following large doses of HSA.

Interactions Between Antipsychotic and Antihypertensive Drugs

1995 ◽  
Vol 29 (6) ◽  
pp. 603-609 ◽  
Author(s):  
John S Markowitz ◽  
Barbara G Wells ◽  
William H Carson
Keyword(s):  
English Language ◽  
Antihypertensive Drugs ◽  
Case Reports ◽  
Data Extraction ◽  
Plasma Concentrations ◽  
Antihypertensive Agents ◽  
Background Information ◽  
Antipsychotic Therapy ◽  
Medline Search ◽  
Pertinent Data

Objective: To provide a comprehensive review of the pharmacokinetic and pharmacodynamic interactions between antipsychotics and antihypertensives and to provide recommendations for the selection of antihypertensives in patients receiving antipsychotic therapy. Data Sources: A MEDLINE search of the English-language literature was used to identify pertinent human and animal studies, reviews, and case reports. Study Selection: All available sources were reviewed. Data Extraction: Background information was obtained from comprehensive reviews. Individual case reports were assimilated, and pertinent data were extracted. Data Synthesis: Because hypertension is common in patients with psychiatric illness and antihypertensive agents are used for a multiplicity of indications, significant numbers of patients receive concurrent therapy with antihypertensives and antipsychotics. Many antipsychotics may block the antihypertensive efficacy of guanethidine and related drugs. The interaction between Clonidine and antipsychotics is defined less clearly. Limited data suggest possible additive hypotensive effects when chlorpromazine and methyldopa are given in combination. Increased plasma concentrations of thioridazine with a resultant increase in adverse effects have been reported when propranolol or pindolol are added to the regimen. A similar increase in chlorpromazine concentrations has been reported when propranolol was added. Although there are no reports documenting an interaction between a calcium-channel antagonist and an antipsychotic, the possible inhibition of oxidative metabolism of antipsychotics, additive calcium-blocking activity, and additive pharmacodynamic effects are theorized. Hypotension and postural syncope were reported in a patient given therapeutic dosages of chlorpromazine and Captopril, and in 2 patients when clozapine was added to enalapril therapy. Conclusions: No antipsychotic-antihypertensive combination is absolutely contraindicated, but no combination should be considered to be completely without risk. Antihypertensives with no centrally acting activity, such as diuretics, may be the least likely to result in adverse reactions. The combination of the beta-antagonists propranolol or pindolol with thioridazine or chlorpromazine should be avoided if possible. Scrupulous patient monitoring for attenuated or enhanced activity of either agent is essential whenever antipsychotics and antihypertensives are given concurrently.

scholarly journals Ibuprofen-Induced Aseptic Meningitis in a Male Adolescent with Intracranial Hypertension and Visual Impairment: A Case Report

2021 ◽  
Vol 13 (1) ◽  
pp. 233-238
Author(s):  
Seyed Mohammad Mousavi Mirzaei ◽  
Zahra Ahmadi
Keyword(s):  
Visual Impairment ◽  
Intracranial Hypertension ◽  
Aseptic Meningitis ◽  
Rare Complication ◽  
Clinical Signs ◽  
Male Adolescent ◽  
Drug Induced ◽  
Blurred Vision ◽  
Inflammatory Drugs

Drug-induced aseptic meningitis (DIAM) is a rare complication of certain drugs, most commonly reported with ibuprofen use. The present study reports on a male adolescent with intracranial hypertension and visual impairment accompanied by DIAM. We present a 16-year-old male patient who after ibuprofen consumption displayed headache, fever, photophobia, and blurred vision following heavy exercises. Examination of cerebrospinal fluid showed a mononuclear pleocytosis and an increase in protein concentration. Other examinations had normal results. The development of common clinical signs following ibuprofen use reflected DIAM. The patient’s vision was found to improve with supportive care and stopping of the drug during follow-up. Given the widespread use of nonsteroidal anti-inflammatory drugs and the fact that these drugs are the most common cause of DIAM, the probability of occurrence of this event should be always kept in mind, and screening for autoimmune diseases in these patients is of great importance.

scholarly journals SARS-CoV-2/DENV co-infection: a series of cases from the Federal District, Midwestern Brazil

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Heidi Luise Schulte ◽  
José Diego Brito-Sousa ◽  
Marcus Vinicius Guimarães Lacerda ◽  
Luciana Ansaneli Naves ◽  
Eliana Teles de Gois ◽  
...  
Keyword(s):  
Clinical Signs ◽  
Federal District ◽  
Therapeutic Interventions ◽  
Diagnostic Process ◽  
The Novel ◽  
Prevention Measures ◽  
Laboratory Findings ◽  
Novel Coronavirus ◽  
The Impact

Abstract Background Since the novel coronavirus disease outbreak, over 179.7 million people have been infected by SARS-CoV-2 worldwide, including the population living in dengue-endemic regions, particularly Latin America and Southeast Asia, raising concern about the impact of possible co-infections. Methods Thirteen SARS-CoV-2/DENV co-infection cases reported in Midwestern Brazil between April and September of 2020 are described. Information was gathered from hospital medical records regarding the most relevant clinical and laboratory findings, diagnostic process, therapeutic interventions, together with clinician-assessed outcomes and follow-up. Results Of the 13 cases, seven patients presented Acute Undifferentiated Febrile Syndrome and six had pre-existing co-morbidities, such as diabetes, hypertension and hypopituitarism. Two patients were pregnant. The most common symptoms and clinical signs reported at first evaluation were myalgia, fever and dyspnea. In six cases, the initial diagnosis was dengue fever, which delayed the diagnosis of concomitant infections. The most frequently applied therapeutic interventions were antibiotics and analgesics. In total, four patients were hospitalized. None of them were transferred to the intensive care unit or died. Clinical improvement was verified in all patients after a maximum of 21 days. Conclusions The cases reported here highlight the challenges in differential diagnosis and the importance of considering concomitant infections, especially to improve clinical management and possible prevention measures. Failure to consider a SARS-CoV-2/DENV co-infection may impact both individual and community levels, especially in endemic areas.

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