背景 一名 82 岁女性因急性发热性疾病和肠系膜脂膜炎就诊，并发展为生化无菌性脑膜炎（脑脊液细胞增多，无可识别病原体）。调查确定她的疾病可能是由柳氮磺吡啶引起的迟发性超敏反应。柳氮磺吡啶诱发的无菌性脑膜炎是一种罕见疾病，由于最初的非特异性疾病症状，需要排除更常见的“危险信号”病因，例如感染和恶性肿瘤，因此通常在患者入院晚期才诊断出来。病例报告 一名 82 岁女性，有反复尿路感染和血清阴性关节炎病史，有 3 天的疲劳、头痛、呼吸困难和倦怠病史。入院时，由于发热和心动过速，她被认为是不明原因败血症。脑计算机断层扫描（CT）显示没有急性颅内异常。此外，胸部、腹部和骨盆的 CT 未显示任何脓毒症来源或恶性肿瘤特征。通过血清学和脑脊液检测排除感染性病因后，诊断为柳氮磺吡啶诱发的无菌性脑膜炎（SIAM）。然后患者开始静脉注射类固醇，导致立即退热和症状缓解。结论 SIAM 仍然是一个诊断挑战，因为患者表现出非特异性体征和症状，如发热、头痛和疲倦。这些患者需要从病史、体格检查、生化检测和放射成像开始进行全面的调查。该病例说明，对于患有发热性疾病的风湿病患者，需要高度怀疑药物引起的过敏反应，并且已确信排除了感染性病因。在 SIAM 中立即开始静脉注射类固醇可显着恢复和缓解症状。

BACKGROUND An 82-year-old woman presented with acute pyrexial illness and mesenteric panniculitis and developed biochemical aseptic meningitis (cerebrospinal fluid pleocytosis with no identifiable pathogen). Investigation determined her illness was likely a delayed hypersensitivity reaction caused by sulfasalazine. Sulfasalazine-induced aseptic meningitis is a rare condition often diagnosed late in a patient's admission owing to initial non-specific illness symptomatology requiring the exclusion of more common "red flag" etiologies, such as infection and malignancy. CASE REPORT An 82-year-old woman with a history of recurrent urinary tract infections and seronegative arthritis presented with a 3-day history of fatigue, headache, dyspnea, and lassitude. On admission, she was treated as presumed sepsis of uncertain source owing to pyrexia and tachycardia. Brain computer tomography (CT) revealed no acute intracranial abnormality. Furthermore, CT of the chest, abdomen, and pelvis did not reveal any source of sepsis or features of malignancy. After excluding infective etiologies with serological and cerebrospinal fluid testing, sulfasalazine-induced aseptic meningitis (SIAM) was diagnosed. The patient was then commenced on intravenous steroids, resulting in immediate defervescence and symptom resolution. CONCLUSIONS SIAM remains a diagnostic challenge since patients present with non-specific signs and symptoms, such as pyrexia, headaches, and lassitude. These patients require a thorough investigative battery starting with anamnesis, physical examination, biochemical testing, and radiologic imaging. This case illustrates the need for a high suspicion index of drug-induced hypersensitivity reaction in a rheumatological patient with pyrexial illness where infective etiologies have been confidently excluded. Prompt initiation of intravenous steroids in SIAM provides a dramatic recovery and resolution of symptoms.