Ciprofloxacin-Induced Encephalopathy

Abstract

Fluoroquinolones (FLQs) are commonly prescribed for infections in both the inpatient and outpatient setting. Though typically well-tolerated, FLQs have been associated with central nervous system adverse effects, especially in older adults and those who metabolize medications at suboptimal rates. Rarely, these drugs can cause serious neurotoxic manifestations, such as seizures, psychosis, or encephalopathy. Although new quinolone derivatives like levofloxacin are most associated with neurotoxic side effects, we show that these unwanted side effects can occur with ciprofloxacin as well. Clinicians should be aware of the neurotoxic side effects of FLQs and its predisposing risk factors, as this is a commonly prescribed class of medication. We aim to contribute to the limited body of literature describing neurotoxic clinical manifestations of FLQs. Herein, we present a case of an 88-year-old male with underlying dementia who presented to the emergency department for evaluation of acute encephalopathy.

Keywords: Ciprofloxacin; Encephalopathy; Fluoroquinolones; Medication adverse effects.

Figure 1

Axial section of a brain magnetic resonance imaging showing mild cortical atrophy (white arrows) and chronic white matter changes (red arrows), without acute pathology.

Figure 2

Graphical representation of the patient’s clinical course demonstrating onset of symptoms and time to recovery. Time is displayed with 0 indicating date of hospital admission and cessation of ciprofloxacin (T = 0). Each day prior is notated by a negative sign and each day after is notated by a positive sign (e.g. T = -5 indicates five days prior to hospital admission).