Cefepime-induced encephalopathy in patient without renal failure

This case report describes neurotoxicity in an older patient on cefepime 2 g twice a day. The 81-year-old male patient developed non-convulsive status epilepticus during cefepime treatment with 1 g twice a day. There was recovery 30 days after discontinuation of cefepime.

Keywords:
Cephalosporins/adverse effects; Cephalosporins/toxicity; Status epileticus/Chemically induced; Aged; Case reports

Authorship

Fernando Morgadinho Santos Coelho Corresponding author: Fernando Morgadinho Santos Coelho - Hospital Israelita Albert Einstein - Avenida Albert Einstein, 627/701 - Morumbi - CEP 05651–901 - São Paulo (SP), Brazil - Tel.: 11 2272–4079 - e-mail: fernandomorgadinho@hotmail.com

Post-doctorate degree at University of Toronto, Canada; MD, Neurologist at Hospital Israelita Albert Einstein – HIAE, São Paulo (SP), Brazil.University of TorontoCanadaToronto, CA, CanadaPost-doctorate degree at University of Toronto, Canada; MD, Neurologist at Hospital Israelita Albert Einstein – HIAE, São Paulo (SP), Brazil.

Post-doctorate degree at University of Toronto, Canada; MD, Neurologist at Hospital Israelita Albert Einstein – HIAE, São Paulo (SP), Brazil.Hospital Israelita Albert Einstein – HIAEBrazilSão Paulo, SP, BrazilPost-doctorate degree at University of Toronto, Canada; MD, Neurologist at Hospital Israelita Albert Einstein – HIAE, São Paulo (SP), Brazil.

Maurício Bernstein

PhD; Cardiologist at Hospital Israelita Albert Einstein – HIAE, São Paulo (SP), Brazil.Hospital Israelita Albert Einstein – HIAEBrazilSão Paulo, SP, BrazilPhD; Cardiologist at Hospital Israelita Albert Einstein – HIAE, São Paulo (SP), Brazil.

Paula Kiyomi Onaga Yokota

Nursing student at Nursing School of Hospital Israelita Albert Einstein – HIAE, São Paulo (SP), Brazil.Hospital Israelita Albert Einstein – HIAEBrazilSão Paulo, SP, BrazilNursing student at Nursing School of Hospital Israelita Albert Einstein – HIAE, São Paulo (SP), Brazil.

Rosilene Motta Elias Coelho

PhD; MD, Nephrologist at Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo – USP, São Paulo (SP), Brazil.Universidade de São Paulo – USPBrazilSão Paulo, SP, BrazilPhD; MD, Nephrologist at Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo – USP, São Paulo (SP), Brazil.

Marcelo Wachemberg

MD, Orthopedist at Hospital Israelita Albert Einstein – HIAE, São Paulo (SP), Brazil.Hospital Israelita Albert Einstein – HIAEBrazilSão Paulo, SP, BrazilMD, Orthopedist at Hospital Israelita Albert Einstein – HIAE, São Paulo (SP), Brazil.

Letícia Pereira de Brito Sampaio

MD, Neurologist at Hospital Israelita Albert Einstein – HIAE, São Paulo (SP), Brazil.Hospital Israelita Albert Einstein – HIAEBrazilSão Paulo, SP, BrazilMD, Neurologist at Hospital Israelita Albert Einstein – HIAE, São Paulo (SP), Brazil.

Luis Otávio Caboclo

PhD; Neurologist at Hospital Israelita Albert Einstein – HIAE, São Paulo (SP), Brazil.Hospital Israelita Albert Einstein – HIAEBrazilSão Paulo, SP, BrazilPhD; Neurologist at Hospital Israelita Albert Einstein – HIAE, São Paulo (SP), Brazil.

Corresponding author: Fernando Morgadinho Santos Coelho - Hospital Israelita Albert Einstein - Avenida Albert Einstein, 627/701 - Morumbi - CEP 05651–901 - São Paulo (SP), Brazil - Tel.: 11 2272–4079 - e-mail: fernandomorgadinho@hotmail.com

SCIMAGO INSTITUTIONS RANKINGS

Figures | Tables

Figures (3)
Tables (1)

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Figure 1
First electroencephalogram showing generalized sharp and slow wave discharges

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Figure 2
Second electroencephalogram showing generalized delta activities, after cefepime was discontinued

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Figure 3
Relationship between creatinine and clearance (by Cockroft-Gault formula)

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Table 1
Creatinine evolution during cefepime treatment

Figure 1 First electroencephalogram showing generalized sharp and slow wave discharges

Figure 2 Second electroencephalogram showing generalized delta activities, after cefepime was discontinued

Figure 3 Relationship between creatinine and clearance (by Cockroft-Gault formula)

Table 1 Creatinine evolution during cefepime treatment

Day	-10	-7	-5	-4	-3	1	3	4	5	6	7	9	11	17
Creatinine (mg/gl)	1.1	1.1	1.3	1.4	1.2	1.0	1.9	1.3	1.1	1.0	1.0	1.1	1.0	1.0
Blood urea nitrogen (mg)	15	11	17	34	37	20	44	48	39	39	39	47	39	21

Cefepime was started in the day 1 and symptoms began in the day 10.

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Cefepime-induced encephalopathy in patient without renal failure

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[1] Corresponding author: Fernando Morgadinho Santos Coelho - Hospital Israelita Albert Einstein - Avenida Albert Einstein, 627/701 - Morumbi - CEP 05651–901 - São Paulo (SP), Brazil - Tel.: 11 2272–4079 - e-mail: fernandomorgadinho@hotmail.com