NONINFECTIOUS MIMICS OF MENINGITIS
Disorders that commonly may be mistaken for meningitis include drug-induced meningitis,
meningeal carcinomatosis, serum sickness, collagen vascular diseases, granulomatous angiitis of
the CNS, Bec ̧het’s disease, systemic lupus erythematosus (SLE), and neurosarcoidosis (1,8,14–
17). The diagnostic approach to the mimics of meningitis is related to the clinical context in
which they occur. For example, lupus cerebritis may rarely present as the sole manifestation of
SLE. Similarly, with Bec ̧het’s disease, patients developing neuro-Bec ̧het’s disease have
established Bec ̧het’s, and have multiple manifestations, which should lead the clinician to
suspect the diagnosis in such a patient. Similarly, with neurosarcoidosis, the presentation is
usually subacute or chronic rather than acute, and occurs in patients with a known history of
sarcoidosis (1,4,5,19–24) (Table 2).
Drug-Induced Aseptic Meningitis
Drug-induced meningitis may present with a stiff neck and fever. The time of meningeal
symptoms after consumption of the medication is highly variable. The most common drugs
associated with drug-induced meningitis include use of nonsteroidal inflammatory drugs. In
addition, trimethoprim–sulfamethoxazole (TMP–SMX) alone, and to a lesser extent,
Table 2 Mimics of Meningitis
lDrug-induced aseptic meningitis
Toxic/metabolic abnormalities
NSAIDs
OKT3
ATG
TMP–SMX
Azathioprine
lCNS vasculitis
lSLE cerebritis
lSarcoid meningitis
lBland emboli from SBE or marantic endocarditis (nonbacterial thrombocytic endocarditis)
lTumor Emboli
lPrimary or metastatic CNS malignancies (meningeal carcinomatosis)
AML
ALL
Hodgkin’s lymphoma
Non-Hodgkin’s lymphoma
Melanoma
Breast carcinomas
Bronchogenic carcinomas
Hypernephromas (renal cell carcinomas)
Germ cell tumors
lLegionnaires’ disease
lPosteria fossa syndrome
lSubarachnoid hemorrhage
Intracerebral hemorrhage
CNS leukostasis
Thrombocytopenia
DIC
Abnormal platelet function
Coagulopathy
CNS metastases
lEmbolic and thrombotic strokes
lPartially treated bacterial meningitis
lMeningoencephalitis
Abbreviations: NSAIDs, nonsteroidal anti-inflammatory drugs; TMP–SMX, trimethoprim–sulfamethoxazole; SLE,
systemic lupus erythematosus; SBE, subacute bacterial endocarditis; ATG, antithymoglobulin; AML, acute
myelogenous leukemia; ALL, acute lymphoblastic leukemia; DIC, diffuse intravascular coagulation; CNS, central
nervous system.
136 Cunha and Smith