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Case Reports
. 2024 Jun 12;16(6):e62254.
doi: 10.7759/cureus.62254. eCollection 2024 Jun.

A Case of Confusion in an Obese Patient Treated With Daptomycin: Neurotoxicity

Rova Malala Fandresena Randrianarisoa  1 , Olivia Raulin  2 , Anthony Merlin  3 , Mathilde Tonnelier  4 , Anne-Lise Lecapitaine  4
Affiliations
Case Reports

A Case of Confusion in an Obese Patient Treated With Daptomycin: Neurotoxicity

Rova Malala Fandresena Randrianarisoa et al. Cureus. .

Abstract

Daptomycin (DAP) is a cyclic lipopeptide antibiotic with bactericidal activity against gram-positive bacteria. The most common adverse reaction is myotoxicity characterized by rhabdomyolysis. Other reported adverse reactions include gastrointestinal symptoms, skin lesions, bleeding, and pulmonary involvement. Neurotoxicity is rare and its mechanism remains partially elucidated. We report a case of confusion consistent with DAP-induced neurotoxicity. A 73-year-old obese man was treated with DAP 9 mg/kg for methicillin-resistant Staphylococcus aureus (MRSA) bacteremia associated with foot osteitis and cervical posterior inter-apophyseal arthritis. On the fifth day of treatment, he developed spatial disorientation, and serum DAP concentrations were very high. DAP-induced neurotoxicity was suggested. His neurological status returned to normal after treatment was stopped. This observation describes a relationship between confusion and DAP that is favored by obesity. Clinicians should be alert for neurologic disorders associated with DAP. It is prudent to reduce doses in obese patients.

Keywords: adverse effects; confusion; daptomycin; neurotoxicity; obesity.

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Conflict of interest statement

Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. PET scan showing hypermetabolic activity in the right inter-apophyseal joint C6-C7 (SUV=5)
A: axial view; B: coronal view; C: sagittal view PET, positron emission tomography
Figure 2
Figure 2. PET scan showing hypermetabolic activity of the fifth radius of the right foot
A: sagittal view; B: axial view PET, positron emission tomography
Figure 3
Figure 3. Axial brain CT scan showing no specific abnormality
Axial CT scan slices, from top (a) to bottom (f) CT, computed tomography
Figure 4
Figure 4. EEG traces showing slowed, poorly organized, symmetrical, and reactive background activity with theta rhythms and bursts of slow delta waves of diffuse projection
EEG, electroencephalogram
See this image and copyright information in PMC

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