Vol.69 No.3 May 2021
Ceftriaxone-induced encephalopathy occurring during hemodialysis: a case report
1)Department of Pharmacy, Saiseikai Futsukaichi Hospital, 3-13-1 Yumachi, Chikushino, Fukuoka, Japan
2)Department of Environmental Medicine and Infectious Disease, Kyushu University
3)Department of Neurology, Saiseikai Futsukaichi Hospital
4)Department of Drug Informatics, Faculty of Pharmaceutical Sciences, Fukuoka University
Abstract
Antimicrobial agents sometimes cause Type I, II, or III antibiotic-associated encephalopathy (AAE). Ceftriaxone (CTRX) reportedly induces Type I AAE, the risk of which is considered to be notably high in the elderly and patients with chronic kidney disease.
A 71-year-old male patient with end-stage renal failure developed AAE after being treated CTRX (2 g/day) for suspected bacteremia complicating ischemic enteritis. We report a case of AAE diagnosed by the cerebrospinal fluid (CSF) concentration of CTRX. On day 6, the patient exhibited abnormal behavior. On day 9, he became unable to communicate and presented right conjugate deviation and repetitive motions. Meningitis was ruled out based on the findings of a CSF specimen obtained by lumbar puncture. We considered encephalitis with encephalopathy to be highly probable because the concentration of CTRX in the CSF (4.87 μg/mL) was four times higher than that in non-meningitis patients. Therefore, we made the diagnosis of AAE with CTRX; when the antibiotic administered was switched from CTRX to levofloxacin, the consciousness level of the patient gradually improved. When CTRX is administered to elderly patients and patients with risk factors such as impaired renal function, attention should be paid to the possible development of AAE. Also, CSF examination is one of the methods to assess the transmissibility of CTRX to the brain, and the measurement of CTRX in the CSF may be useful for the diagnosis of AAE.
Key word
ceftriaxone, adverse effect, antibiotic-associated encephalopathy, cerebrospinal fluid concentration, hemodialysis
Received
September 11, 2020
Accepted
January 7, 2021
Jpn. J. Chemother. 69 (3): 286-292, 2021
