Abstract
Drug-induced neurotoxicity is a rare adverse reaction associated with ertapenem. Encephalopathy is a type of neurotoxicity that is defined as a diffuse disease of the brain that alters brain function or structure. We report a patient with normal renal function who developed ertapenem-induced encephalopathy manifesting as altered mental status, hallucinations, and dystonic symptoms. The patient’s symptoms improved dramatically following ertapenem discontinuation, consistent with case reports describing ertapenem neurotoxicity in renal dysfunction. Since clinical evidence strongly suggested ertapenem causality, we utilized the Naranjo Scale to estimate the probability of an adverse drug reaction to ertapenem. Our patient received a Naranjo Scale score of 7, suggesting a probable adverse drug reaction, with a reasonable temporal sequence to support our conclusion.
Highlights
IntroductionDrug-induced neurotoxicity is a rare adverse reaction associated with carbapenem antibiotics.[1,2,3] The data demonstrating a neurotoxic association for carbapenems stems from animal models, observational analyses, randomized controlled trials, meta-analysis, and case reports.[1,2,3,7,8,9,10,11,12,13,14] Imipenem is considered to have the highest incidence of neurotoxicity among carbapenems, there are published literature that refute this consensus.[3,7,15,16,17,18,19] Encephalopathy is a type of neurotoxicity that is defined as a diffuse disease of the brain that alters brain function or structure
There are case reports of ertapenem neurotoxic effects consisting of encephalopathy in patients with end-stage renal disease or mild renal dysfunction
We report a patient with normal renal function who developed ertapenem-induced encephalopathy manifesting as altered mental status, hallucinations, and dystonic symptoms
Summary
Drug-induced neurotoxicity is a rare adverse reaction associated with carbapenem antibiotics.[1,2,3] The data demonstrating a neurotoxic association for carbapenems stems from animal models, observational analyses, randomized controlled trials, meta-analysis, and case reports.[1,2,3,7,8,9,10,11,12,13,14] Imipenem is considered to have the highest incidence of neurotoxicity among carbapenems, there are published literature that refute this consensus.[3,7,15,16,17,18,19] Encephalopathy is a type of neurotoxicity that is defined as a diffuse disease of the brain that alters brain function or structure. There are case reports of ertapenem neurotoxic effects consisting of encephalopathy in patients with end-stage renal disease or mild renal dysfunction. We report a patient with normal renal function who developed ertapenem-induced encephalopathy manifesting as altered mental status, hallucinations, and dystonic symptoms. Atorvastatin 80 mg daily Cephalexin 500 mg every 12 hoursa Diltiazem 120 mg daily Ertapenem 1 g dailyb Fluconazole 600 mg daily Gabapentin 300 mg 3 times per day as needed Glipizide 10 mg twice daily Metformin 500 mg twice daily Metoprolol tartrate 25 mg twice daily Rivaroxaban 20 mg daily aCephalexin was discontinued 2 weeks priors to presentation for altered mental status. Ertapenem was stopped and ceftazidime 2 g every 8 hours was started His hallucinations and related neurological symptoms began to improve and the patient recovered to his baseline mental status within 2 days
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