Ceftiaxone-induced neurotoxicity: case report, pharmacokinetic considerations, and literature review

Abstract

Ceftriaxone is widely used in patients for the treatment of serious gram-negative infections. Ceftriaxone can induce some potential side effects, including neurotoxicity, however, nonconvulsive status epilepticus has rarely been reported. We report a case of acute reversible neurotoxicity associated with ceftriaxone. A 65-yr-old woman with chronic kidney disease developed altered consciousness during ceftriaxone treatment for urinary tract infection. The electroencephalogram demonstrated continuous bursts of generalized, high-voltage, 1 to 2 Hz sharp wave activity. Neurologic symptoms disappeared following withdrawal of ceftriaxone. The possibility of ceftriaxone-induced neurotoxicity should be considered in patients developing neurological impairment during ceftriaxone use, and the discontinuation of the drug could lead to complete neurological improvement.

Keywords: Ceftriaxone; Cephalosporins; Chronic Kidney Failure; Seizures.

Fig. 1

Electroencephalogram (EEG) findings during nonconvulsive status epilepticus and recovery state. (A) EEG on day 22, when the patient presented an altered mental state. An EEG showed generalized slowing of the background with superimposed almost continuous bursts of generalized, moderate to high amplitude that had an almost periodic pattern (arrows). (B) EEG on day 24, when the patient's neurologic symptoms resolved completely. Epileptiform discharges had disappeared.

Fig. 2

Abdomen/Pevis CT showing the extensive thrombosis (arrowheads). (A) Thrombosis in the inferior vena cava. (B) Thrombosis in the renal vein.