Cefepime-Induced Encephalopathy With Seizures in a Pediatric Patient With End-Stage Renal Disease Rapidly Reversed by High-Efficiency Hemodialysis

Abstract

Cefepime-induced encephalopathy with associated complications is a relatively rare but known adverse reaction that appears to occur more commonly in the elderly population with concomitant renal dysfunction or pre-existing central nervous system disease. The description of neurological features in pediatric patients secondary to cefepime-induced encephalopathy has rarely been reported, often delaying diagnosis and treatment. We report a 13-year-old female with end-stage renal disease, maintained on hemodialysis, who developed acute neurological symptoms of aphasia, myoclonus, hallucinations, seizures, and altered mental status after two days of cefepime treatment. After prompt discontinuation of cefepime and urgent hemodialysis, the neurological symptoms were resolved. Our patient had complete neurological recovery within 24 hours of the initial presentation of neurological symptoms. Recognizing the possibility of encephalopathy related to cefepime administration in high-risk pediatric patients should prompt close neurological monitoring when under treatment. Hemodialysis may help rapidly reverse the symptoms of cefepime-induced encephalopathy.

Keywords: cefepime; encephalopathy; hemodialysis; high-efficiency.

Figure 1. Abnormal EEG showing non-convulsive status epilepticus.

EEG: electroencephalogram.

Figure 2. EEG showing resolution of status epilepticus following pharmacotherapy.

EEG: electroencephalogram.