• Giulia Pata, Marco Montagna, Emanuele Bosi, Alberto Davalli, and Patrizia Rovere Querini.
• Vita-Salute San Raffaele University, Milan, Italy.
• Medicine (Baltimore). 2023 Jan 6; 102 (1): e32475e32475.

RationaleDrug-induced aseptic meningitis (DIAM) is an uncommon meningitis and trimethoprim with or without sulfamethoxazole is the most involved antibiotic. Although DIAM is easily treated with the discontinuation of the causative drug, the diagnosis is a big challenge for physicians, as it remains a diagnosis of exclusion. Here, we present a case report of trimethoprim-sulfamethoxazole induced aseptic meningitis in a woman with acute osteomyelitis.Patient ConcernsA 52-year-old woman was admitted to the hospital for septic shock and acute osteomyelitis of the right homerus. She was started on antibiotic therapy with oxacillin and daptomycin, then oxacillin was replaced with cotrimoxazole, due to its excellent tissue penetration, including bone tissue. During cotrimoxazole therapy, the patient developed a fluent aphasia with ideomotor apraxia and muscle hypertonus.Diagnosis And InterventionsHaving excluded infectious, epileptic and vascular causes of the acute neurologic syndrome of our patient, given the improvement and full recovery after discontinuation of cotrimoxazole, we hypothesized a DIAM.OutcomesAfter discontinuation of cotrimoxazole, in 48 hours the patient had a full recovery.LessonsAlthough DIAM can be easily managed with the withdrawal of the causative drug, it can be difficult to recognize if it is not included in the differential diagnosis. An antimicrobial stewardship program with a strict monitoring of patients by infectious disease specialists is essential, not only to optimize the appropriate use of antimicrobials, but also to improve patient outcomes and reduce the likelihood of adverse events.Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.

26 keywords...

hide…