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Recurrent Ibuprofen-Induced Aseptic Meningitis

Medical Student, Sunnybrook and Women's College Health Sciences Centre, Toronto, Ontario, Canada

David N Juurlink, BPhm MD PhD

Staff Physician, Divisions of General Medicine and Clinical Pharmacology, Sunnybrook and Women's College Health Sciences Centre

Reprints: David N Juurlink BPhm MD PhD, G Wing 106, Sunnybrook and Women's College Health Sciences Centre, 2075 Bayview Ave., Toronto, Ontario M4N 3M5, Canada, fax 416/480-6048, david.juurlink{at}ices.on.ca

OBJECTIVE: To report a case of recurrent aseptic meningitis temporally associated with the use of ibuprofen.

CASE SUMMARY: A previously well 51-year-old white man presented with acute confusion and aphasia 7 days after taking a variety of nonprescription medications, including ibuprofen. Imaging of the brain was unremarkable, and lumbar puncture revealed lymphocytic pleocytosis with an elevated protein level. The symptoms improved shortly after admission, and no infectious cause was identified. Two weeks later, the patient was readmitted with similar symptoms beginning immediately after resumption of ibuprofen. His symptoms resolved promptly after ibuprofen was discontinued.

DISCUSSION: Drug-induced aseptic meningitis is an unusual complication of drug therapy. Nonsteroidal antiinflammatory drugs (NSAIDs), particularly ibuprofen, are among the most commonly implicated agents, but rechallenge with the suspected agent is uncommon. Use of an objective causality tool indicated a probable relationship between ibuprofen and development of aseptic meningitis in our patient.

CONCLUSIONS: Clinicians should consider NSAIDs as potential causes of aseptic meningitis, especially in patients with recurrent illness and no obvious infectious cause. A detailed drug history is invaluable in the assessment of such patients, with particular attention to nonprescription medications such as ibuprofen.

Key Words: aseptic meningitis, ibuprofen

Published Online, January 12, 2004. www.theannals.com, DOI 10.1345/aph.1D329

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