Cefepime-induced encephalopathy in patient without renal failure

Coelho, Fernando Morgadinho Santos; Bernstein, Maurício; Yokota, Paula Kiyomi Onaga; Coelho, Rosilene Motta Elias; Wachemberg, Marcelo; Sampaio, Letícia Pereira de Brito; Caboclo, Luis Otávio

doi:10.1590/S1679-45082010RC1121

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Case Report • Einstein (São Paulo) 8 (3) • Jul-Sep 2010 • https://doi.org/10.1590/S1679-45082010RC1121 linkcopy

Cefepime-induced encephalopathy in patient without renal failure

Authorship SCIMAGO INSTITUTIONS RANKINGS

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

person Fernando Morgadinho Santos Coelho

schoolPost-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.schoolPost-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.

person Maurício Bernstein

schoolPhD; 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.

person Paula Kiyomi Onaga Yokota

schoolNursing 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.

person Rosilene Motta Elias Coelho

schoolPhD; 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.

person Marcelo Wachemberg

schoolMD, 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.

person Letícia Pereira de Brito Sampaio

schoolMD, 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.

person Luis Otávio Caboclo

schoolPhD; 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

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.

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.

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.

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.

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.

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.

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.

Figures | Tables

Figures (3)
Tables (1)

Thumbnail

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

imageFigure 1 First electroencephalogram showing generalized sharp and slow wave discharges open_in_new

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

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

table_chartTable 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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