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  • Meningitis is defined as an inflammation of the meninges. Commonly has an infectious etiology. May also be drug-induced (focus of this SMQ). 1) Aseptic meningitis: Characterized by CSF mononuclear pleocytosis and an absence of bacteria on examination and culture. May be caused by viruses. Rare but well-recognized complication of drug therapy. Drug-induced aseptic meningitis (DIAM) has distinct presentation with fever, neck stiffness, headache, confusion, nausea and vomiting. Major categories of causative agents are nonsteroidal anti-inflammatory drugs (NSAIDs), antimicrobials, intravenous immunoglobulins, monoclonal antibodies and vaccines. 2) Chronic meningitis: Meningeal inflammation lasting more than one month. Causative agents include chemotherapy drugs that are injected directly into the CSF (e.g., methotrexate), drugs used in organ transplantation (e.g., cyclosporine and OKT3) and even NSAIDs. Symptoms similar to those of acute bacterial meningitis, but develop more slowly and gradually; fever often less severe. Include headache, confusion, backache, weakness, numbness, and facial paralysis. Mixed disorders such as encephalomyelitis, encephalomyeloradiculitis, or encephalo-myelopathy may present with overlapping symptoms.
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