09 March 2020
: Case report
Cefepime-Induced Neurotoxicity Presenting with Nonconvulsive Status Epilepticus Admitted as a Stroke Alert
Unusual or unexpected effect of treatment, Adverse events of drug therapy
John M. Cunningham12EF*, Katherine V. Sachs12EF, Rebecca Allyn12EFDOI: 10.12659/AJCR.921643
Am J Case Rep 2020; 21:e921643
Abstract
BACKGROUND: Cefepime-induced neurotoxicity has been described in intensive care units (ICUs) and neuro ICU settings, occurring in patients started on cefepime for management of severe infections and sepsis. Most cases occur within 1 to 10 days after starting the drug. We publish a case that occurred on the general medical ward of a patient who had been on cefepime therapy for 4 weeks prior to admission. The aim of this study was to improve the knowledge of this serious condition to general internists as our patient was being managed on the general medical ward.
CASE REPORT: A 72-year-old female on prolonged intravenous antibiotics for sacral and pelvic osteomyelitis presented with acute encephalopathy and aphasia in the setting of an acute kidney injury. Due to the acute focal neurologic deficit, she was initially admitted as a stroke alert. After a negative magnetic resonance imaging (MRI) of the brain, an electroencephalogram (EEG) was pursued and showed nonconvulsive status epilepticus (NCSE). NCSE was likely a result of cefepime therapy in the setting of an acute kidney injury.
CONCLUSIONS: Cefepime-induced neurotoxicity should be suspected in any patient on cefepime therapy who develops acute changes in mental status, myoclonus, or evidence of seizures. Risk factors for the disease include older age, renal dysfunction, critical illness, and inappropriate dosing based upon renal function. A high index of suspicion is required and delays in diagnosis are common as there are frequently multiple possible causes for altered mental status in systemically ill patients requiring treatment with broad-spectrum antibiotics.
Keywords: Aphasia, cephalosporins, Epilepsy, Generalized, Neurotoxicity Syndromes, Acute Kidney Injury, Aged, Anti-Bacterial Agents, Anticonvulsants, Brain Diseases, cefepime, Levetiracetam, Lorazepam, osteomyelitis, Status epilepticus
SARS-CoV-2/COVID-19
04 July 2022 : Case report
Am J Case Rep In Press; DOI: 10.12659/AJCR.934468
29 June 2022 : Case report
Am J Case Rep In Press; DOI: 10.12659/AJCR.936896
16 June 2022 : Case report
Am J Case Rep In Press; DOI: 10.12659/AJCR.936498
13 June 2022 : Case report
Am J Case Rep In Press; DOI: 10.12659/AJCR.936889
In Press
07 Jul 2022 : Case report
Am J Case Rep In Press; DOI: 10.12659/AJCR.937305
06 Jul 2022 : Case report
Am J Case Rep In Press; DOI: 10.12659/AJCR.936313
05 Jul 2022 : Case report
Am J Case Rep In Press; DOI: 10.12659/AJCR.936585
05 Jul 2022 : Case report
Am J Case Rep In Press; DOI: 10.12659/AJCR.935885
Most Viewed Current Articles
23 Feb 2022 : Case report
DOI :10.12659/AJCR.935250
Am J Case Rep 2022; 23:e935250
17 Feb 2022 : Case report
DOI :10.12659/AJCR.934399
Am J Case Rep 2022; 23:e934399
06 Dec 2021 : Case report
DOI :10.12659/AJCR.934406
Am J Case Rep 2021; 22:e934406
09 Feb 2022 : Case report
DOI :10.12659/AJCR.934744
Am J Case Rep 2022; 23:e934744