90005772

open access

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Cefepime-induced encephalopathy

English (英語)

BMJ Case Reports

2018

bcr2017-223954

BMJ

2018

2019-04-01

61-year-old man has been unable to leave his bed since being diagnosed with cerebral palsy at the age of 2 years. He is fed via a gastrostoma and has previously contracted aspiration pneumonitis three times. He has had no history of seizures or myoclonic movements until the time of hospitalisation. He visited a physician with complaints of fever lasting for 1 week and a cough that had been increasing in severity. He was diagnosed with pneumonia and treated with 100 mg oral cefcapene three times a day. As his condition did not improve, he was referred to our hospital for treatment. A chest X-ray and CT scan revealed abscess formation in the right middle lobe of the lung, and he was diagnosed with pulmonary suppuration. Initially, he was given 2 g of ceftriaxone every 24 hours. Following detection of Pseudomonas aeruginosa in the sputum culture, we discontinued ceftriaxone and initiated treatment with 2 g of cefepime, an antibacterial drug, every 12 hours, depending on creatinine clearance (55 mL/min). After 4 days of treatment with cefepime, there was no change in his state of consciousness; however, myoclonic movements were observed in his face, upper limbs and trunk (video 1) for the first time. As we suspected that such symptoms were a side effect of cefepime treatment, we changed the antibacterial drug to 2 g of ceftazidime, which was administered every 8 hours. Three days after he stopped using cefepime, his myoclonic movements stopped. Such developments indicated cefepime-induced encephalopathy. Since then, there have been no further incidents of myoclonus observed. He was discharged after undergoing antibacterial drug treatment for a total of 4 weeks

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