Drug-Induced Aseptic Meningitis: A 25-Year Systematic Review of Case Reports

Objectives This systematic review characterizes drug-induced aseptic meningitis (DIAM), a rare but clinically significant adverse drug reaction. The study synthesizes data from published case reports and case series to enhance diagnostic accuracy and guide management strategies. Methods A comprehensive literature search was conducted in PubMed/MEDLINE, Scopus, Embase, Cochrane Library, ClinicalTrials.gov, and grey literature following PRISMA guidelines. Cases with detailed clinical and therapeutic data were included. Results A total of 98 reports involving 108 patients were analyzed. The mean patient age was 47 years, with a slight female predominance (55%). The most commonly implicated drugs were nonsteroidal anti-inflammatory drugs, antibiotics, and monoclonal antibodies. Symptoms typically included headache (78%), fever (65%), and neck stiffness (56%), with severe neurological manifestations in 17%. Cerebrospinal fluid analysis showed pleocytosis in 65% and elevated protein in 60%. Magnetic resonance imaging findings were variable. Drug discontinuation led to symptom resolution in all cases, with corticosteroids used in severe presentations. Conclusions DIAM mimics infectious meningitis, making early recognition critical. A thorough patient history, including medication exposure, is essential for diagnosis. This review underscores the need for clinician awareness to facilitate prompt identification and management. Future research should explore the immunopathogenesis and evidence-based treatment strategies for DIAM. PROSPERO Registration number: CRD42024590886