Metronidazole-Associated Aseptic Meningitis

SIR-Metronidazole is commonly used in the treatment of bacterial vaginosis and trichomonal vaginal infections, various anaerobic infections, intestinal giardiasis, and amoebiasis. We report a case of recurrent meningitis in a patient who received therapy with metronidazole. A 20-year-old woman presented to the emergency department with severe diffuse headache, fever, arthralgias, and myalgias of sudden onset. She had recently been evaluated for vaginal discharge, which contained clue cells without white blood cells, and a whiff test (10% KOH was added to the discharge sample) was positive. Therapy with metronidazole was prescribed for presumed bacterial vaginosis. She had taken a single 250-mg dose of metronidazole the morning of her admission to the hospital. Physical examination revealed a mildly toxic-appearing woman with a temperature of 101?F and a supple neck; the remainder of her examination did not reveal any abnormalities. Laboratory tests performed on admission revealed a white blood cell count of 21.4/mm3 (88% neutrophils, 7% band forms, 2% eosinophils, 1% monocytes, and 2% atypical lymphocytes). Analysis of CSF revealed a red blood cell count of 5/mm3 and a white blood cell count of 13/mm3 (8 neutrophils). Levels of protein and glucose in CSF were normal; findings of gram staining and results of culture were negative. The patient recovered uneventfully and was discharged on the third hospital day without treatment.