Arch Hand Microsurg.  2023 Mar;28(1):63-66. 10.12790/ahm.22.0057.

Cefepime-induced neurotoxicity after flap surgery: a rare case report

• Song WJ
• Lee CY
• Ryu HR
• Byeon JY
• Choi HJ

• KMID: 2540034
• DOI: http://doi.org/10.12790/ahm.22.0057

Abstract

Cefepime is a fourth-generation cephalosporin that covers gram-positive bacteria and gram-negative bacteria, such as Pseudomonas. A 48-year-old male patient underwent a posterior tibial artery perforator-based fasciocutaneous turnover flap and was administered cefepime. After 2 days, the patient showed neurological symptoms, such as cognitive decline and aphasia. We immediately stopped cefepime and changed to ciprofloxacin. In addition, thiamine was administered and additional dialysis was performed. The neurological symptoms were resolved after tapering cefepime and hemodialysis. In patients undergoing flap surgery, especially those with impaired renal function, cefepime should be administered carefully considering the risk of neurotoxicity.

Keyword

Cefepime; Drug-related side effects and adverse reactions; Neurotoxicity syndromes

Figure

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  Fig. 1. Photograph of the initial finding. Gross preoperative photographic image with the raw surface of the lateral malleolar area.

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  Fig. 2. Photograph of postoperative findings. (A) The flap is healthy with pale-pinkish skin color and normal turgor on postoperative day 1. (B) On postoperative day 2, there is diffuse congestion on the flap site. (C) On postoperative day 31, the congestion was resolved and the grafted skin was taken-up.

Reference

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