Ibuprofen-induced Meningitis

A man came to the emergency room with strange symptoms. He had previously been diagnosed with viral meningitis because of a high white cell count in a spinal tap -but no infectious agent was found. And his symptoms weren't consistent with the diagnosis. Then the doctor remembered another strange case he'd read about.

In a Vital Signs column in this magazine 17 years ago, infectious-disease physician Abigail Zuger described the conundrum of a young woman with recurrent meningitis. Hospitalized four times in a matter of months, the patient exhibited high fevers, delirium, and a stiff neck—all signs of life-threatening ?bacterial, septic meningitis. CAT scans were normal. Spinal taps revealed high white cell counts in the cerebrospinal fluid—usually a harbinger of severe infection—but bacterial and viral cultures grew nothing. The patient was becoming ill and then abruptly getting better. The fourth time, to general eye-rolling, a medical student was tasked with asking the woman for the umpteenth time whether she had taken anything, anything, prior to getting sick. He hit pay dirt: Advil.

Zuger’s patient hadn’t considered over-the-counter, everyday Advil a medication. It is also sold as Rufen or Motrin, and the chemical moniker is ibuprofen. Ubiquitous as this drug is, until reading Zuger’s article I hadn’t known that in rare cases it can cause meningitis.

Case reports are the lifeblood of diagnosis. The dry, reductionist, what-percent-have-cough and what-percent-have-fever lists in medical texts will put you to sleep. But good stories stick. Doctors trade odd diagnoses like baseball cards; we glean them from journals, TV, and friends, stockpiling them against the next tough diagnosis. Zuger’s story—even 16 years later—primed me to jump on one small clue.

Ibuprophen-induced meningitis is rare, but it explained everything about this particular patient. Read the rest at Discover magazine. Link -via TYWKIWDBI