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

Behet syndrome

SLE

Sjgren 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
 subarachnoid space Antibiotics

Chemotherapy drugs

Radiopaque dyes
Pertussis
Vaccines
Rabies

Smallpox

Noninfectious meningitis causes symptoms (eg, headache, fever, nuchal rigidity) that are
similar to those caused by other kinds of meningitis. Severity and acuity can vary, 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). CSF findings may include

Lymphocytic or neutrophilic pleocytosis

Elevated protein
Usually normal glucose

Causative disorders are treated, and causative drugs are stopped. Otherwise, treatment is
supportive.

If patients appear seriously ill, appropriate antibiotics and corticosteroids are started
immediately (without waiting for tests results) and continued until acute bacterial meningitis
is ruled out (ie, CSF is shown to be sterile).