sulindac and Meningitis

A 21-year-old female with mixed connective tissue disease (MCTD) experienced nausea, headache, consciousness disturbance, nuchal rigidity, and a temperature of 38.5 less than or equal to C three days after the intake of sulindac (300 mg/day). Cerebrospinal fluid analysis revealed an opening pressure of 310 mm of water, a predominantly lymphocytic pleocytosis, and elevated protein content of 89 mg/dl. After discontinuing sulindac, the aseptic meningitis improved in five days. In the acute stage, CT scan disclosed contrast enhancement in the cerebral hemispheres, which suggests that hypersensitivity may be involved in the pathogenesis of nonsteroidal antiinflammatory drug (NSAID) induced aseptic meningitis.

Topics: Adult; Female; Humans; Indenes; Meningitis; Meningitis, Aseptic; Mixed Connective Tissue Disease; Sulindac

The association of nonsteroidal anti-inflammatory drugs (NSAIDs) and recurrent aseptic meningitis has been only rarely noted in patients without underlying connective tissue disease. I have described a patient who had four episodes of unexplained meningitis for which no auto-inflammatory or infectious cause could be found. Three of the episodes were found to have been immediately preceded by sulindac doses. The patient has tolerated aspirin, indomethacin, naproxyn, fenoprofen, diflunisal, and ibuprofen before and since this association was noted, implying an immunologic hypersensitivity to sulindac and not a pharmacologic effect of the entire class of such drugs.

Topics: Anti-Inflammatory Agents, Non-Steroidal; Diagnosis, Differential; Female; Humans; Indenes; Meningitis; Meningitis, Aseptic; Middle Aged; Recurrence; Sulindac

Topics: Adult; Female; Humans; Indenes; Meningitis; Mixed Connective Tissue Disease; Sulindac

Topics: Aged; Blood Cell Count; Female; Humans; Indenes; Leukocyte Count; Meningitis; Meningitis, Aseptic; Osteoarthritis; Recurrence; Sulindac

A 22-year-old woman with systemic lupus erythematosus experienced generalized pruritus, shortness of breath, pleuritic chest pain, visual blurring, severe photophobia, a stiff neck, an occipital headache, and a temperature of 39.4 degrees C within one hour after taking sulindac (Clinoril). Findings from a CSF examination disclosed a notable elevation of protein and a polymorphonuclear pleocytosis. All symptoms disappeared within 24 hours. Inhibition of prostaglandin synthesis did not seem to be the mechanism of this adverse reaction, since the patient tolerated aspirin.

Topics: Adult; Drug Hypersensitivity; Female; Humans; Indenes; Lupus Erythematosus, Systemic; Meningitis; Meningitis, Aseptic; Sulindac