Ceftriaxone sodium–associated encephalopathy presented with schizophrenic and catatonic features : a case report

Abstract

A 29–year–old woman presented with schizophrenic features, such as paranoia, hallucinations, and disorganized speech, and catatonia features such as agitation, stupor, mutism, stereotypes, and posturing after an injection of ceftriaxone sodium against Streptococcus pneumoniae pneumonia. The diagnosis of ceftriaxone sodium–associated encephalopathy was suspected, as these findings improved after the discontinuation of ceftriaxone sodium. Patients with this disease present with psychological and neurological symptoms such as disturbance of consciousness, seizures, and myoclonus. However, details of the former are unknown. Based on previous reports, we note that schizophrenic and catatonic features are distinctive psychological symptoms of this disease. The pathophysiology of schizophrenia and catatonia involves dysfunction of the gamma–aminobutyric acid (GABA) system. We hypothesized that antagonism at the GABA_A receptor in ceftriaxone sodium might induce these symptoms due to a dysfunction of the GABA systems. Therefore, ceftriaxone sodium–associated encephalopathy should be considered in psychological symptoms during administration.