Abstract
Aseptic meningitis has been reported in association with the administration of non-steroidal anti-inflammatory drugs, including ibuprofen, tolumetin and sulindac. Most of the patients reported have had connective tissue diseases, as SLE and MCTD.
In this report, we described a case of aseptic meningitis caused by sulindac in a patient of rheumatoid arthritis with Raynaud's phenomenon and pulmonary fibrosis. In July 1983, a 58 years old woman who had a history of Raynaud's phenomenon for two years and pulmonary fibrosis for one year, complained polyarthralgia. She was diagnosed as rheumatoid arthritis based on morning stiffness, polyarthritis, and positive rheumatoid factors. Since August, arthritis had been controlled by a dose of 75mg of diclofenac and 50mg of indomethacin. In December, because of epigastric pain, she began taking sulindac of 300mg per day instead of indomethacin. But after 13 days, she was hospitalised because of fever, headache and meningeal signs. Lumbar puncture yeilded cerebrospinal fluid with 257/3 cells, glucose value of 58mg/dl, and protein value of 152mg/dl. She also had pleuropericarditis and disseminated intravascular coagulation syndrome during the hospital course. Discontinuation of sulindac resolved these above symptoms in the next 4 days. She had not been rechallenged with sulindac.
Although the mechanism of the meningitis is far from clear, past history of drug allergy, eosinophilia, positive findings of lymphocyte stimulation test for slindac and the rapid resolution of meningeal symptoms after cessation of the drug suggest that allergic or immunological mechanisms induced by sulindac might be involved in our patients.
