Like father, like daughter: amoxicillin-induced aseptic meningitis in a female patient and her father: a case report

BACKGROUND: Drug-induced aseptic meningitis (DIAM) is a neurological disorder that requires specialized diagnostic pathways and an in-depth patient history to prevent inaccurate diagnoses and unnecessary procedures. Amoxicillin has been reported as one of the drugs causing recurrent DIAM, with a total of 22 patients described in the literature. CASE PRESENTATION: We report two cases involving patients of Mediterranean ethnicity -a father (69-years-old) and his daughter (47-years-old)-who presented to our neurology department at different time points with severe headache persisting for several days. Both patients disclosed recent use of amoxicillin to treat bronchitis and otitis. In both cases, examination of cerebrospinal fluid (CSF) revealed leukocytosis with lymphocytic predominance, while no causative pathogens were identified. After extensive investigations to rule out other causes of secondary headache, a diagnosis of amoxicillin-induced aseptic meningitis (AIAM) was established. Notably, the daughter experienced two similar episodes, both temporally associated with amoxicillin intake. CONCLUSIONS: Amoxicillin-induced aseptic meningitis is a rare adverse reaction that should be considered in patients presenting with severe headache in the absence of an identifiable pathogen. A thorough patient history combined with comprehensive diagnostic evaluation is essential to establish the diagnosis and to avoid unnecessary or excessive treatment. Additionally, potential genetic predispositions, as suggested in other forms of drug-induced aseptic meningitis, may play a role and should be considered in selected cases.