Clinical Scorecard: Postpartum-Onset Seizures Associated With Ibuprofen-Induced Aseptic Meningitis: A Case Report

At a Glance

Key Highlights

• An 11-day-postpartum patient developed headache, fever, altered behavior, and new-onset seizures after taking ibuprofen 600 mg three times daily for 10 days.
• CSF showed lymphocytic pleocytosis, markedly increased protein, normal glucose, and sterile cultures; comprehensive infectious investigations were negative.
• Neuroimaging and electroencephalography showed no significant abnormalities.
• Antibiotics were stopped on hospital day two given the low probability of infection. The patient recovered after ibuprofen discontinuation, and no readmissions were recorded over the subsequent year.

Guideline-Based Recommendations

Diagnosis

• The authors identify ibuprofen-induced aseptic meningitis as a diagnostic consideration when meningeal symptoms occur with negative infectious investigations and recent ibuprofen exposure.
• The authors state that diagnosis depends on ruling out infection and identifying a temporal association with the medication.
• In this case, the Naranjo adverse drug reaction probability score was 6, indicating a probable adverse drug reaction.

Management

• Ibuprofen was discontinued, after which the patient recovered.
• Antibiotics were stopped on hospital day two given the low probability of infection; the patient was observed for clinical worsening.
• The patient's hypocalcemia and hypomagnesemia were treated with intravenous calcium gluconate and magnesium sulfate.

Monitoring & Follow-up

• The patient was observed for clinical worsening after antibiotics were stopped; no seizures occurred during hospitalization.
• The patient was discharged with planned outpatient neurology and gynecology follow-up.

Risks

• Drug-induced aseptic meningitis may resemble bacterial meningitis and result in unnecessary antimicrobial treatment.
• The source describes seizures as a less frequent manifestation of ibuprofen-induced aseptic meningitis.
• The source reports an association with autoimmune conditions and notes uncertainty about whether aseptic meningitis may be an initial manifestation of autoimmune disease.

Patient & Prescribing Data

A 23-year-old woman, 11 days after cesarean delivery, without significant medical history.

She had taken over-the-counter ibuprofen 600 mg three times daily for 10 days for postoperative pain, in addition to oxycodone. Symptoms resolved after ibuprofen was discontinued.

Clinical Best Practices

• The authors emphasize obtaining a medication history in patients with aseptic meningitis.
• The authors describe antibiotic stewardship in the context of negative infectious investigations.
• The case report notes reported associations between ibuprofen-induced aseptic meningitis and autoimmune conditions; autoimmune testing in this patient did not identify an explanation.

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