Reactions 561 - 29 Jul 1995

SCephalosporins

Recurrent aseptic meningitis in an elderly patient:case report

A 66-year-old woman developed aseptic meningitis aftercefazolin therapy, then again after ceftazidime therapy. Fiveyears previously, she had also experienced aseptic meningitisafter a 2-week course of cephalexin.

The woman began parenteral cefazolin [dosage not stated]for prophylaxis against infection, and dexamethasone for backpain, following a vertebral compression fracture. Five dayslater, she developed fever, chills, severe back pain, headache,confusion and lethargy. A lumbar puncture showed a WBCcount of 376/mm3, a RBC count of 150/mm3, a protein level of192 mg/dl and a glucose level of 67 mg/dl.

Antibacterial prophylaxis was changed to IV ceftazidime[dosage not stated]. However, 2 days later, the woman’scondition had worsened and both ceftazidime anddexamethasone were stopped. Although CSF bacterial, fungaland mycobacterial cultures were negative, antituberculartherapy was started. A tuberculosis test was later found to benegative. Further investigations showed that the CSF IgG indexwas increased and specific IgG-ceftazidime binding was seen.

Because of the possibility of a viral infection causingmeningitis, the woman was started on a 2-week course ofempirical aciclovir. She was also treated with generalsupportive care. Clinical recovery was apparent and her CSFhad improved by day 36.

The woman had no skin reaction to cephalosporinsensitivity testing. However, 2 days later, she developedencephalitis and had a recurrence of aseptic meningitis. Sheresponded rapidly to a 3-day course of methylprednisoloneand was discharged on hospital day 48 after being advised toavoid cephalosporins. She did not experience any furtherepisodes of meningitis during 3 years of follow-up.Creel GB, et al. Cephalosporin-induced recurrent aseptic meningitis. Annals ofNeurology 37: 815-817, Jun 1995 - USA 800373484

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Reactions 29 Jul 1995 No. 5610114-9954/10/0561-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved