Meropenem-induced myoclonus: A case report

Abstract

A 61-year-old woman was seen at the intensive care unit because of myoclonic status. Her medical history included arterial hypertension, dyslipidemia and diabetes. In the previous year she had been hospitalized because of dilated cardiomyopathy (ejection fraction 21%) and non-sustained ventricular tachycardia. At that time she was managed with an implantable cardiac defibrillator. On this admission she complained of precordial pain and had heart failure with a cold and dry profile, for which she was given vasoactive drugs and an intra-aortic balloon. Her coronary angiography was unremarkable, but a lower limb echo-Doppler revealed a high-flow arteriovenous fistula between the right superficial femoral artery and vein. The fistula was not managed surgically because of the patient’s clinical status. In the following days her dyspnea worsened, requiring non-invasive ventilation, and her central catheter became colonized. She developed oliguria, vomiting, hypoglycemia, syncope and cardiac arrest, which was successfully managed with cardiopulmonary resuscitation (CPR). A urinary infection ensued 5 days later and as her renal function had decreased, intravenous meropenem 1000 mg/day was started (dosing for CrCl of 10–25 mL/min: 500–1500 mg/day). Soon after