Antibiotics associated encephalopathy after ceftriaxone sodium infusion in a patient with end–stage renal disease : a case report

Abstract

Antibiotics associated encephalopathy (AAE) is a rare complication of antibiotic use, especially beta–lactam antibiotics including ceftriaxone sodium (CTRX). AAE has been reported to present various neurological symptoms such as choreoathetosis, myoclonus, and altered level of consciousness. An 81–year–old man with end–stage renal disease experienced exacerbation of chronic heart failure. CTRX 2g/d infusion was administered intravenously for the prevention of bacterial pneumonia. On day 5, his consciousness level suddenly deteriorated, and choreoathetosis developed involving the neck, trunk, and limbs. There were no significant findings in blood test, cerebrospinal fluid test, and brain magnetic resonance imaging. His serum CTRX level was remarkably high as 307.0µg/ml. He was then diagnosed with AAE due to CTRX infusion. Approximately two weeks after discontinuation of the CTRX therapy, neurological symptoms completely resolved. Dosage adjustment of CTRX for patients with end–stage renal disease should be warranted.