Allergy Asthma Respir Dis.  2014 Jul;2(3):213-217. 10.4168/aard.2014.2.3.213.

Cefepime-induced encephalopathy without renal impairment

• Kim SH
• Nam YH
• Jeon DS
• Lee HW
• Nam HJ
• Lee SK

• KMID: 2262522
• DOI: http://doi.org/10.4168/aard.2014.2.3.213

Abstract

Cefepime is an extended-spectrum, fourth-generation cephalosporin that has been widely used for approved indications such as febrile neutropenia. Common adverse events of cefepime include headache, skin rash, gastrointestinal problems, and fever. However, encephalopathathy caused by cefepime has been sporadically reported worldwide over the last decade. We experienced a rare case of cefepime-induced encephalopathy. A 75-year-old man with a 30-year history of chronic obstructive pulmonary disease was admitted to the medical intensive care unit under a diagnosis of pneumonia. Initial antibiotic therapy was started with piperacillin/sulbactam and ciprofloxacin. His condition was improved with this treatment. About 2 months later, his condition was aggravated again, with mild fever and purulent sputum. Intravenous cefepime was selected on the basis of antibiotic susceptibility to Pseudomonas aeruginosa isolated from his sputum. However, his mentality became drowsy 48 hours after cefepime adminstration. He showed tremors and right facial paralysis. Neurologic examination for motor power and sensory function revealed normal findings. Laboratory tests, including serum electrolytes, glucose, osmolality, and ammonia, gave normal results. Brain magnetic resonance imaging showed chronic ischemic and atropic changes, and an electroencephalography revealed triphasic waves. The administration of cefepime was stopped, and his symptoms started to improve within 48 hours. Electroencephalography results became normalized, and he completely recovered within 48 hours after discontinuation of cefepime.

Keyword

Cefepime; Nervous system disorder; Electroencephalography

MeSH Terms

Aged
Ammonia
Brain
Ciprofloxacin
Diagnosis
Electroencephalography
Electrolytes
Exanthema
Facial Paralysis
Febrile Neutropenia
Fever
Glucose
Headache
Humans
Intensive Care Units
Magnetic Resonance Imaging
Nervous System Diseases
Neurologic Examination
Osmolar Concentration
Pneumonia
Pseudomonas aeruginosa
Pulmonary Disease, Chronic Obstructive
Sensation
Sputum
Tremor
Ammonia
Ciprofloxacin
Electrolytes
Glucose

Figure

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  Fig. 1 Brain magnetic resonance imaging shows chronic ischemic and atropic changes.

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  Fig. 2 The initial electroencephalography showed the triphasic nonconvulsive ictal wave (A), and the electroencephalography became normal shape without triphasic wave after discontinuance of cefepime (B). The green square box indicates triphasic ictal wave in frontal lobe.

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  Fig. 3 The change of blood urea nitrogen (BUN) and creatinine during hospital admissions was presented.

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