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Pharmacist, Pharmacy Department, Centre Universitaire Mère-Enfant Ste-Justine, 3175 Côte Ste-Catherine, Montréal, Quebec H3T 1C5, Canada, fax 514/345-4899, roxane. therrien.hsj{at}ssss.gouv.qc.ca
Reprints: Roxane Therrien MSc
OBJECTIVE: To report a case of trimethoprim/sulfamethoxazole (TMP/SMX)-induced aseptic meningitis.
CASE SUMMARY: An 18-year-old woman diagnosed with acute myeloid leukemia was admitted for a bone marrow transplant. She had already attained remission with daunorubicin, thioguanine, and high-dose cytarabine. A routine lumbar puncture performed on admission revealed an abnormally elevated leukocyte count, and meningitis was suspected. The patient had been taking TMP/SMX (trimethoprim 120 mg) twice daily on Monday, Tuesday, and Wednesday for the past 3 months; no other medication was being used. Upon examination, the patient mentioned having had headaches for the past few weeks. Since viral, bacterial, and fungal cultures were negative, a diagnosis of aseptic meningitis was made. According to the Naranjo probability scale, TMP/SMX was a possible cause of the aseptic meningitis. Eleven days after discontinuation of TMP/SMX, lumbar puncture results had returned to normal.
DISCUSSION: Many drugs have been associated with aseptic meningitis. Antibiotics are often linked with aseptic meningitis, with TMP/SMX being the most frequently associated antibiotic. Many cases of TMP/SMX-induced aseptic meningitis have been reported, while few cases have been reported with trimethoprim and sulfamethoxazole given separately.
CONCLUSIONS: Despite the widespread use of TMP/SMX and the years of experience we have had with the drug, it is important to remain vigilant regarding possible adverse effects, particularly aseptic meningitis.
Key Words: aseptic meningitis, co-trimoxazole, Septra, trimethoprim/sulfamethoxazole
Published Online, September 14, 2004. www.theannals.com, DOI 10.1345/aph.1D581
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