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Noninfectious Meningitis

By John E. Greenlee, MD

Last full review/revision November 2015 by John E. Greenlee, MD

Meningitis is occasionally caused by noninfectious conditions (eg, noninfectious disorders, drugs,
vaccines). Many cases of noninfectious meningitis are subacute or chronic.

Some Noninfectious Causes of Meningitis

Type Examples

Type Examples
Metastatic cancer
Disorders
Sarcoidosis

Behçet syndrome

SLE

Sjögren syndrome

RA

Rupture of an intracranial cysticercal or epidermoid cyst
Azathioprine
Drugs with anti-inflammatory
or immune-modulating effects Cyclosporine

Cytosine arabinoside

IVIG

Muromonab-CD3 (OKT3)

NSAIDs (most commonly, ibuprofen)
Certain antibiotics (eg, ciprofloxacin, isoniazid,
Other drugs penicillin, trimethoprim/sulfamethoxazole)

Carbamazepine

Phenazopyridine

Ranitidine
Anesthetics
Substances injected into the

fever. nuchal rigidity) that are similar to those caused by other kinds of meningitis. subarachnoid space Antibiotics Chemotherapy drugs Radiopaque dyes Pertussis Vaccines Rabies Smallpox Noninfectious meningitis causes symptoms (eg. . treatment is supportive. headache. CSF findings may include  Lymphocytic or neutrophilic pleocytosis  Elevated protein  Usually normal glucose Causative disorders are treated. appropriate antibiotics and corticosteroids are started immediately (without waiting for tests results) and continued until acute bacterial meningitis is ruled out (ie. If patients appear seriously ill. CSF is shown to be sterile). but noninfectious meningitis tends to be less severe than acute bacterial meningitis. Diagnosis of noninfectious meningitis is based on analysis of CSF obtained by lumbar puncture (preceded by neuroimaging if increased intracranial pressure or an intracranial mass effect is suspected). Severity and acuity can vary. Otherwise. and causative drugs are stopped.