Ceftriaxone-Induced Encephalopathy in a Patient With Chronic Kidney Disease

TL;DR

A 56-year-old woman with chronic kidney disease developed neurological symptoms linked to ceftriaxone, which improved after stopping the drug, highlighting its rare but reversible neurotoxic effect.

Contribution

This case report highlights ceftriaxone as a potential cause of reversible encephalopathy, particularly in patients with chronic kidney disease.

Findings

The patient's neurological symptoms resolved after discontinuing ceftriaxone.

Ceftriaxone-induced encephalopathy was considered the most likely diagnosis after ruling out other causes.

The case emphasizes the need for clinicians to recognize this rare adverse effect.

Abstract

Neurotoxicity is an acknowledged side effect of third and fourth-generation cephalosporins, but its occurrence with ceftriaxone is not widely recognized. This article presents a case involving a 56-year-old woman with multiple comorbidities who sought medical attention after experiencing lipothymia. The initial diagnosis suggested a urinary tract infection with acute kidney failure, leading to the initiation of ceftriaxone and hemodialysis. Subsequently, the patient exhibited a progressive deterioration of her neurological state, characterized by agitation and chorea. Metabolic encephalopathy, seizure/nonconvulsive status epilepticus, and acute central nervous system lesions were considered primary differential diagnoses, all of which were subsequently ruled out through thorough investigations. Days later, a remarkable recovery of the patient's neurological state was observed. A retrospective analysis revealed a correlation between the improvement and the fourth day of antimicrobial suspension. Consequently, a presumptive diagnosis of ceftriaxone-induced encephalopathy was made. This unusual case underscores the importance of recognizing the potential for pharmacological encephalopathy, particularly with ceftriaxone, and emphasizes its reversibility upon discontinuation of the implicated drug. Clinicians should remain vigilant to this uncommon adverse effect, promoting timely intervention and improved patient outcomes.

Figures