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Ceftriaxone-induced acute encephalopathy in a peritoneal dialysis patient.

Safadi S, Mao M, Dillon JJ - Case Rep Nephrol (2014)

Bottom Line: Encephalopathy is a rare side effect of third and fourth generation cephalosporins.Renal failure and preexisting neurological disease are notable risk factors.This case illustrates the potential severe neurologic effects of cephalosporins, which are recommended by international guidelines as first-line antimicrobial therapy for spontaneous bacterial peritonitis.

View Article: PubMed Central - PubMed

Affiliation: Division of Nephrology and Hypertension, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905, USA.

ABSTRACT
Encephalopathy is a rare side effect of third and fourth generation cephalosporins. Renal failure and preexisting neurological disease are notable risk factors. Recognition is important as discontinuing the offending agent usually resolves symptoms. We present a case of acute encephalopathy in a patient with end stage renal disease (ESRD) treated with peritoneal dialysis (PD) who received intravenous ceftriaxone for peritonitis. This case illustrates the potential severe neurologic effects of cephalosporins, which are recommended by international guidelines as first-line antimicrobial therapy for spontaneous bacterial peritonitis.

No MeSH data available.


Related in: MedlinePlus

Awake EEG using transverse Laplacian montage, showing normal 9 Hz alpha rhythm in the posterior head regions, as well as abnormal 5-6 Hz theta and 2–4 Hz delta slowing seen diffusely but most prominent in the right posterior temporal (P8), parietal (P4), and occipital (O2) head regions.
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Related In: Results  -  Collection


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fig1: Awake EEG using transverse Laplacian montage, showing normal 9 Hz alpha rhythm in the posterior head regions, as well as abnormal 5-6 Hz theta and 2–4 Hz delta slowing seen diffusely but most prominent in the right posterior temporal (P8), parietal (P4), and occipital (O2) head regions.

Mentions: She was initially treated with intraperitoneal ceftazidime (125 mL/L). Two days later, she was hospitalized for possible sepsis as her PD cultures grew Yersinia enterocolitica. She was switched to intravenous ceftriaxone (2 grams daily). PD was continued. She defervesced quickly and remained hemodynamically stable and her blood cultures were negative. After 3 days of intravenous ceftriaxone, the patient developed agitation, paranoia, and visual hallucinations. The neurological examination was nonfocal. An EEG (Figure 1) showed background moderate diffuse nonspecific slowing without epileptogenic activity. An MRI showed cerebral and cerebellar volume loss but no focal findings to account for the patient's symptoms. She was not receiving any pain medications or centrally acting agents at the time. Furthermore, hallucinations occurred a few hours after ceftriaxone infusions, so ceftriaxone was suspected. The symptoms resolved completely, within 36 hours, after ceftriaxone was switched to ciprofloxacin.


Ceftriaxone-induced acute encephalopathy in a peritoneal dialysis patient.

Safadi S, Mao M, Dillon JJ - Case Rep Nephrol (2014)

Awake EEG using transverse Laplacian montage, showing normal 9 Hz alpha rhythm in the posterior head regions, as well as abnormal 5-6 Hz theta and 2–4 Hz delta slowing seen diffusely but most prominent in the right posterior temporal (P8), parietal (P4), and occipital (O2) head regions.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4273507&req=5

fig1: Awake EEG using transverse Laplacian montage, showing normal 9 Hz alpha rhythm in the posterior head regions, as well as abnormal 5-6 Hz theta and 2–4 Hz delta slowing seen diffusely but most prominent in the right posterior temporal (P8), parietal (P4), and occipital (O2) head regions.
Mentions: She was initially treated with intraperitoneal ceftazidime (125 mL/L). Two days later, she was hospitalized for possible sepsis as her PD cultures grew Yersinia enterocolitica. She was switched to intravenous ceftriaxone (2 grams daily). PD was continued. She defervesced quickly and remained hemodynamically stable and her blood cultures were negative. After 3 days of intravenous ceftriaxone, the patient developed agitation, paranoia, and visual hallucinations. The neurological examination was nonfocal. An EEG (Figure 1) showed background moderate diffuse nonspecific slowing without epileptogenic activity. An MRI showed cerebral and cerebellar volume loss but no focal findings to account for the patient's symptoms. She was not receiving any pain medications or centrally acting agents at the time. Furthermore, hallucinations occurred a few hours after ceftriaxone infusions, so ceftriaxone was suspected. The symptoms resolved completely, within 36 hours, after ceftriaxone was switched to ciprofloxacin.

Bottom Line: Encephalopathy is a rare side effect of third and fourth generation cephalosporins.Renal failure and preexisting neurological disease are notable risk factors.This case illustrates the potential severe neurologic effects of cephalosporins, which are recommended by international guidelines as first-line antimicrobial therapy for spontaneous bacterial peritonitis.

View Article: PubMed Central - PubMed

Affiliation: Division of Nephrology and Hypertension, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905, USA.

ABSTRACT
Encephalopathy is a rare side effect of third and fourth generation cephalosporins. Renal failure and preexisting neurological disease are notable risk factors. Recognition is important as discontinuing the offending agent usually resolves symptoms. We present a case of acute encephalopathy in a patient with end stage renal disease (ESRD) treated with peritoneal dialysis (PD) who received intravenous ceftriaxone for peritonitis. This case illustrates the potential severe neurologic effects of cephalosporins, which are recommended by international guidelines as first-line antimicrobial therapy for spontaneous bacterial peritonitis.

No MeSH data available.


Related in: MedlinePlus