@article{10.11648/j.ajim.20210902.19,
  author = {Lea Scherschinski and Laura Baudier and Marie-Luise Mono and Lars Christian Huber and Nora Christe},
  title = {Amoxicillin-Induced Meningoencephalitis: Case Report and Review of the Literature},
  journal = {American Journal of Internal Medicine},
  volume = {9},
  number = {2},
  pages = {102-106},
  doi = {10.11648/j.ajim.20210902.19},
  url = {https://doi.org/10.11648/j.ajim.20210902.19},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajim.20210902.19},
  abstract = {Amoxicillin is one of the most frequently prescribed antibiotics for common bacterial infections in the primary care setting. Although being considered one of the safest drugs, amoxicillin can induce a rare hypersensitivity reaction with direct leptomeningeal irritation leading to drug-induced aseptic meningoencephalitis (DIAM). Given its rare incidence and poorly elucidated risk factors, amoxicillin-induced aseptic meningoencephalitis remains a diagnostic challenge. We report here the case of an 82-year-old male who presented to our emergency department with fever and cellulitis on the left foot. Antibiotic therapy with amoxicillin-clavulanate was established. Two days after admission, the patient developed frontal headaches, nausea, photophobia, and nuchal rigidity, while remaining febrile. In addition, intermittent episodes of amnesic aphasia, confusion, and agitation were observed. Cerebrospinal fluid (CSF) analysis revealed mononuclear-predominant pleocytosis, without detecting a causative pathogen by culture or PCR screening. Repeated and focused exploration of the patient's medical history unraveled a similar episode of severe cephalgia with mononuclear-predominant pleocytosis on CSF analysis after the intake of amoxicillin-clavulanate 15 years before the current presentation. The combination of clinical signs for leptomeningeal irritation following ingestion of a distinct medication and the lack of evidence for a causative pathogen on CSF analysis, were suggestive of DIAM. DIAM is most commonly caused by nonsteroidal anti-inflammatory drugs, antibiotics and intravenous immunoglobulins. DIAM remains a diagnosis of exclusion. Its pathomechanism is still not completely understood. Our illustrative case emphasizes the key points of this rare but important diagnosis. In the context of our report, we review all published cases of amoxicillin-induced meningoencephalitis. Our case report may increase the awareness of this challenging diagnosis.},
 year = {2021}
}

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TY  - JOUR
T1  - Amoxicillin-Induced Meningoencephalitis: Case Report and Review of the Literature
AU  - Lea Scherschinski
AU  - Laura Baudier
AU  - Marie-Luise Mono
AU  - Lars Christian Huber
AU  - Nora Christe
Y1  - 2021/04/26
PY  - 2021
N1  - https://doi.org/10.11648/j.ajim.20210902.19
DO  - 10.11648/j.ajim.20210902.19
T2  - American Journal of Internal Medicine
JF  - American Journal of Internal Medicine
JO  - American Journal of Internal Medicine
SP  - 102
EP  - 106
PB  - Science Publishing Group
SN  - 2330-4324
UR  - https://doi.org/10.11648/j.ajim.20210902.19
AB  - Amoxicillin is one of the most frequently prescribed antibiotics for common bacterial infections in the primary care setting. Although being considered one of the safest drugs, amoxicillin can induce a rare hypersensitivity reaction with direct leptomeningeal irritation leading to drug-induced aseptic meningoencephalitis (DIAM). Given its rare incidence and poorly elucidated risk factors, amoxicillin-induced aseptic meningoencephalitis remains a diagnostic challenge. We report here the case of an 82-year-old male who presented to our emergency department with fever and cellulitis on the left foot. Antibiotic therapy with amoxicillin-clavulanate was established. Two days after admission, the patient developed frontal headaches, nausea, photophobia, and nuchal rigidity, while remaining febrile. In addition, intermittent episodes of amnesic aphasia, confusion, and agitation were observed. Cerebrospinal fluid (CSF) analysis revealed mononuclear-predominant pleocytosis, without detecting a causative pathogen by culture or PCR screening. Repeated and focused exploration of the patient's medical history unraveled a similar episode of severe cephalgia with mononuclear-predominant pleocytosis on CSF analysis after the intake of amoxicillin-clavulanate 15 years before the current presentation. The combination of clinical signs for leptomeningeal irritation following ingestion of a distinct medication and the lack of evidence for a causative pathogen on CSF analysis, were suggestive of DIAM. DIAM is most commonly caused by nonsteroidal anti-inflammatory drugs, antibiotics and intravenous immunoglobulins. DIAM remains a diagnosis of exclusion. Its pathomechanism is still not completely understood. Our illustrative case emphasizes the key points of this rare but important diagnosis. In the context of our report, we review all published cases of amoxicillin-induced meningoencephalitis. Our case report may increase the awareness of this challenging diagnosis.
VL  - 9
IS  - 2
ER  - 

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