A 52-year-old woman was admitted to the hospital for septic shock and acute osteomyelitis of the right homerus. She was started on antibiotic therapy with oxacillin and daptomycin, then oxacillin was replaced with cotrimoxazole, due to its excellent tissue penetration, including bone tissue. During cotrimoxazole therapy, the patient developed a fluent aphasia with ideomotor apraxia and muscle hypertonus.
Results
b) Discontinuation of cotrimoxazole
Cotrimoxazole was discontinued and in 48 hours the patient had a full recovery. Drug-induced aseptic meningitis (DIAM) was hypothesized after excluding infectious, epileptic and vascular causes of the acute neurologic syndrome of this patient. DIAM is an uncommon meningitis and trimethoprim with or without sulfamethoxazole is the most involved antibiotic. Although DIAM is easily treated with the discontinuation of the causative drug, the diagnosis is a big challenge for physicians, as it remains a diagnosis of exclusion
