Ertapenem-associated seizures in a patient without prior CNS disorder or severe renal dysfunction

Abstract

To present a case report of a patient who had developed seizures during ertapenem therapy with no central nervous system (CNS) disorder and the dose of ertapenem that is apparently appropriate according to the renal function. Seizures are rare but well known side-effects of carbapenems, especially imipenem. In most cases, seizures develop in patients with CNS lesions and limited carbapenem excretion. We present a case of a female patient with no prior central nervous disorder who developed seizures after 3 days of ertapenem therapy. In the first 2 days, the dose of ertapenem was halved according to the calculated creatinine clearance. On day 3, the renal function improved, and according to the recommendation by the manufacturer there was no need for dose adjustment any more. Seizures stopped after the discontinuation of ertapenem and anti-epileptic prophylaxis with levetiracetam. A literature search of similar case reports has shown that seizures during ertapenem treatment may develop in patients with prior known CNS disorders and/or severe renal dysfunction that predicts dose alteration according to renal function. There are reports of changed mental status with no convulsive movements, and there is known decrease of valproic acid concentration during ertapenem treatment in patients treated for various forms of epilepsy. To our knowledge, this is the first report of ertapenem-related seizures in a patient with normal CNS function and the dose of ertapenem that was appropriate for her renal function. With our case report, we would like to inform and warn clinicians of the possibility of new onset epilepsy during ertapenem treatment, even in individuals with pre-existing moderate chronic kidney disease and no prior known CNS disease.