LETTER
Aseptic Meningitis and Intravenous Immunoglobulin Therapy
W. E. Peetermans;
E. Van Wijngaerden; and
D. C. Knockaert
15 February 1995 | Volume 122 Issue 4 | Pages 316-317
TO THE EDITOR:
Sekul and colleagues [1] and the accompanying editorial[2] discussed the clinical picture and incidence of aseptic meningitis with predominant neutrophil pleocytosis that was associated with high-dose intravenous immunoglobin therapy. The issue of additional antibiotic therapy pending the results of microbiological diagnosis was not addressed. No reliable rapid diagnostic test is available to exclude bacterial meningitis in these patients, who are frequently immune compromised; in patients with bacterial meningitis, early administration of antibiotic therapy is critical for a positive outcome. Indeed, the standard of care consists of administration of antibiotics within 30 minutes after a patient with suspected bacterial meningitis is encountered[3]. It therefore seems prudent to treat patients empirically with antibiotics if they have a clinical picture of acute meningitis and a cerebrospinal fluid pleocytosis with granulocytic predominance. This strategy seems warranted because despite rapid resolution of this syndrome of immunoglobin therapy-associated meningitis, additional hospitalization of 2 to 3 days was frequently required [1].
In a recently described patient with acute neutrophilic meningitis associated with immunoglobulin treatment[4] and in most other reported cases, antibiotics were given for a few days until cerebrospinal fluid cultures were negative for bacterial meningitis and until the suspected diagnosis of aseptic meningitis was confirmed by the rapid clinical resolution.
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Author and Article Information
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Baylor College of Medicine, Houston, TX 77030. University Hospital, K. U. Leuven, 3000 Leuven, Belgium. National Institutes of Health, Bethesda, MD 20892-1382.
1. Sekul EA, Cupler EJ, Dalakas MC. Aseptic meningitis associated with high-dose intravenous immunoglobulin therapy: frequency and risk factors. Ann Intern Med. 1994; 121:259-62.
2. Scribner CL, Kapit RM, Phillips ET, Rickles NM. Aseptic meningitis and intravenous immunoglobulin therapy (Editorial). Ann Intern Med. 1994; 121:305-6.
3. Talan DA, Zibulewsky J. Relationship of clinical presentation to time to antibiotics for the emergency department management of suspected bacterial meningitis. Ann Emerg Med. 1993; 22:1733-8.
4. De Vlieghere FC, Peetermans WE, Vermylen J. Aseptic granulocytic meningitis following treatment with intravenous immunoglobulin. Clin Infect Dis. 1994; 18:1008-10.[Medline]
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