TABLE 1.
Main criteria for DIAM differential diagnosis.
| DIAM (Yelehe-Okouma et al., 2018) | Bacterial meningitis (Hasbun, 2022) | Fungal meningitis (Bystritsky and Chow, 2022) | Viral meningitis (Gundamraj and Hasbun, 2023) | Tuberculous meningitis (Mount and Boyle, 2017) | Neoplastic meningitis (Tattevin et al., 2019) | Systemic diseases with meningeal involvement (Tattevin et al., 2019) | ||
|---|---|---|---|---|---|---|---|---|
| Etiology | NSAIDs, antibiotics, IVIG, monoclonal antibodies, and antiepileptic drugs | Streptococcus pneumoniae, group B Streptococcus, Neisseria meningitidis, Haemophilus influenzae, and Listeria monocytogenes | Cryptococcus neoformans, Cryptococcus gattii, Coccidioides, Histoplasma, Blastomyces, and Sporothrix schenckii | Enteroviruses, herpesviruses, mumps and measles viruses, arboviruses, and lymphocytic choriomeningitis virus | Mycobacterium tuberculosis | Leukemia, lymphoma, breast cancer, lung cancer, and melanoma | Sarcoidosis, Behcet’s disease, Sjögren syndrome, systemic lupus erythematosus, and granulomatosis with polyangiitis | |
| Clinical features | Headache, altered consciousness, fever, and myalgia | Fever, neck stiffness, altered mental status, and headache | Headache, fever, cranial nerve, and other focal neurologic deficits | Headache, fever, neck stiffness, and altered mental status | Headache, fever, cranial nerve, and other focal neurologic deficits | Multifocal neurological lesions, cranial nerve palsies, and cognitive impairment | Cranial nerves palsy, meningoencephalitis, cerebral vasculitis, polyneuropathy, convulsions, and pseudotumor cerebri | |
| CSF | Pressure | Elevated | Elevated | Elevated | Normal | Normal or elevated | Elevated | - |
| Cells (×106/L) | 300 | >1,000 | Variable | <1,000 | 100–500 | Elevated | >50 or <50 | |
| Cell type | Neutrophils or lymphocytes | Neutrophils | Lymphocytes | Lymphocytes | Lymphocytes | Tumor cells | Neutrophils or lymphocytes | |
| Protein | Elevated | Elevated | Normal or elevated | Normal or elevated | Elevated | - | - | |
| Glucose | Normal | Reduced | Normal or reduced | Normal | Reduced | - | - | |
| Lactates | <3.5 mM | >3.5 mM | - | <3.5 mM | - | - | - | |
| Other criteria | Sterile | Bacterial culture | Fungal culture, (1,3)-β-D-glucan | PCR, and NGS | Mycobacterium tuberculosis culture, acid-fast bacilli staining, tuberculin skin testing, interferon-gamma release assay | - | Primary diseases | |
| Management | Discontinuation of the causative drugs | Ampicillin, ceftriaxone, vancomycin, third-generation cephalosporin, oxacillin, corticosteroids | Amphotericin B, flucytosine, fluconazole, liposomal amphotericin B, itraconazole | Acyclovir | Isoniazid, rifampin, pyrazinamide, streptomycin, ethambutol, corticosteroids | Check-point inhibitors, monoclonal antibodies | Treatment of primary diseases | |
| Time to regression | Within a few days | 7–21 days | >4 weeks | 7–15 days | >4 weeks | - | - | |
| Outcome | Favorable | Poor | Poor | Favorable | Poor | Poor | - | |
Abbreviations: DIAM: drug-induced aseptic meningitis; NSAIDs: non-steroidal anti-inflammatory drugs; IVIG: intravenous immunoglobulin; CSF: cerebrospinal fluid; PCR: polymerase chain reaction; NGS: next-generation sequencing.