Case report with the change on MR scans in the cefepime-induced encephalopathy

초록

Background & Significance: Cefepime is a fourth-generation cephalosporin antibiotic and has a broad antimicrobial spectrum against grampositive and gram-negative bacteria. It is commonly used antibiotic in nosocomial infections because it is more versatile and effective than thirdgeneration cephalosporin antibiotics. Rare adverse reactions, related to this antibiotic include neurotoxicity, encephalopathy, amyotrophy and convulsion. Here, we reported a case of encephalopathy in a patient with confusion after cefepime administration and brain MR scans revealed a lesion on diffusion weighted image (DWI). Case: An 86-year-old man was admitted for empyema and pneumonia. He had the history of hypertension, prostatic hyperplasia, and coronary artery occlusive disease. Chest X-ray and chest CT performed in the emergency department indicated bilateral pneumonic infiltrates with empyema and pleural effusion. He took was a secondgeneration cephalosporin antibiotic and metronidazole 500 for one week. The antibiotics were changed to clindamycin and cefepime due to increased WBCs and worsening pneumonia infiltrates without symptomatic improvement. He was alert on admission and became stuporous on day 14th of clindamycin and cefepime medication. Brain DWIs showed high signal intensities in the left posterior horn. An EEG showed continuous generalized theta to delta slowing and triphasic waves, without spike or sharp waves, compatible with nonconvulsive status epilepticus (NCSE). Two weeks after discontinuation of cefepime and administration of valproic acid and benzodiazepine, patient's consciousness improved from drowsy to alert, with recovery of spontaneous eye opening and orientation. The follow-up EEG revealed the slow waves without triphasic waves or epileptiform discharges. Conclusions or Comments: The patient presented a sudden confusion after cefepime administration with DWI lesions in left occipital horn and abnormalities on EEG. We thought that this case would be