PMID- 32147665
OWN - NLM
STAT- MEDLINE
DCOM- 20201117
LR  - 20201117
IS  - 1941-5923 (Electronic)
IS  - 1941-5923 (Linking)
VI  - 21
DP  - 2020 Mar 9
TI  - Cefepime-Induced Neurotoxicity Presenting with Nonconvulsive Status Epilepticus 
      Admitted as a Stroke Alert.
PG  - e921643
LID - 10.12659/AJCR.921643 [doi]
AB  - 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.
FAU - Cunningham, John M
AU  - Cunningham JM
AD  - Division of Hospital Medicine, Department of Medicine, Denver Health Medical 
      Center, Denver, CO, USA.
AD  - University of Colorado School of Medicine, Denver, CO, USA.
FAU - Sachs, Katherine V
AU  - Sachs KV
AD  - Division of Hospital Medicine, Department of Medicine, Denver Health Medical 
      Center, Denver, CO, USA.
AD  - University of Colorado School of Medicine, Denver, CO, USA.
FAU - Allyn, Rebecca
AU  - Allyn R
AD  - Division of Hospital Medicine, Department of Medicine, Denver Health Medical 
      Center, Denver, CO, USA.
AD  - University of Colorado School of Medicine, Denver, CO, USA.
LA  - eng
PT  - Case Reports
PT  - Journal Article
DEP - 20200309
PL  - United States
TA  - Am J Case Rep
JT  - The American journal of case reports
JID - 101489566
RN  - 0 (Anti-Bacterial Agents)
RN  - 0 (Anticonvulsants)
RN  - 44YRR34555 (Levetiracetam)
RN  - 807PW4VQE3 (Cefepime)
RN  - O26FZP769L (Lorazepam)
SB  - IM
MH  - Acute Kidney Injury/chemically induced
MH  - Aged
MH  - Anti-Bacterial Agents/administration & dosage/*adverse effects
MH  - Anticonvulsants/therapeutic use
MH  - Aphasia/chemically induced
MH  - Brain Diseases/chemically induced
MH  - Cefepime/administration & dosage/*adverse effects
MH  - Female
MH  - Humans
MH  - Levetiracetam/therapeutic use
MH  - Lorazepam/therapeutic use
MH  - Osteomyelitis/drug therapy
MH  - Status Epilepticus/*chemically induced/drug therapy
PMC - PMC7081951
COIS- Conflict of interest: None declared Conflict of interests None.
EDAT- 2020/03/10 06:00
MHDA- 2020/11/18 06:00
PMCR- 2020/03/09
CRDT- 2020/03/10 06:00
PHST- 2020/03/10 06:00 [entrez]
PHST- 2020/03/10 06:00 [pubmed]
PHST- 2020/11/18 06:00 [medline]
PHST- 2020/03/09 00:00 [pmc-release]
AID - 921643 [pii]
AID - 10.12659/AJCR.921643 [doi]
PST - epublish
SO  - Am J Case Rep. 2020 Mar 9;21:e921643. doi: 10.12659/AJCR.921643.