Abstracts

Rationale: Cefepime induced encephalopathy and status epilepticus have been described, especially in patients with renal failure. We report a case of probable aphasia which progressed to status epilepticus, associated with Cefepime use.Methods: We report a patient with Cefepime induced neurotoxicity presenting initially as probable aphasia followed by encephalopathy and status epilepticus. Results: We present a case of a 59 year-old, right-handed man with chronic renal failure and cervical myelopathy with residual quadriparesis who was admitted for treatment of sepsis from multiple infectious sources, including infected sacral decubitii, cellulitis and a pseudomonas urinary tract infection. Cefepime 2g/day was added to his regimen to broaden the coverage. Five days after initiation of Cefepime, he developed word finding difficulty with stuttering of his speech. Exam at that time showed that he was awake and alert, with non fluent speech, impaired naming and repetition. Comprehension was spared. An ischemic event was suspected. His MRI brain did not reveal any acute changes. Subsequently, over the next two days, he developed progressive confusion with no verbal output and intermittent myoclonic movements of the extremities. His first EEG during the progressive confusion showed intermittent generalized sharp waves activity. Another EEG done a day later showed continuous periodic generalized sharp wave activity at 1-2/sec. At this time, review of his medications revealed that he was being administered Cefepime in a non-renal impaired dosage. Cefepime was discontinued and he was treated with IV Valproic acid. His CSF examination was within normal limits. His BUN was 65 and creatinine was 2.32. Over the next 3-4 days, his mental status gradually improved to baseline. A follow-up EEG at that time showed complete resolution of epileptiform activity, with some diffuse slowing of the background. Conclusions: Cefepime neurotoxicity can initially be associated with changes in speech manifest as aphasia, followed by encephalopathy and nonconvulsive status epilepticus. Nonconvulsive status epilepticus should be considered in the differential diagnosis of unexplained changes in mental status, especially in sick patients with multiple medical problems. Cefepime, when used in patients with renal failure, should be appropriately dosed. Providers need to be aware of Cefepime induced neurotoxicity and its clinical manifestations.