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[Encephalopathy induced by fleroxacin in a patient with Machado-Joseph disease]
M Kimura1, J Fujiyama, A Nagai
1Second Department of Intenal Medicine, Fukui Medical University.
Abstract:
Convulsive seizure with unconciousness is an adverse effect of new quinolone antibiotics including fleroxacin. A block of GABA receptor in CNS has been reported as pathomechanism. A 48-year-old female patient with Machado-Joseph disease (MJD) had encephalopathy induced by fleroxacin. She revealed unconsciousness after the administration of fleroxacin (200mg/day) for three days. Electroencephrogram (EEG) showed diffuse slow waves. The administration was discontinued and her consciousness became clear after a day. The abnormal findings on EEG disappeared gradually. The concentrations of fleroxacin were within normal limits in serum and cerebrospinal fluid. The patient with MJD might have a tendency to develop encephalopathy by fleroxacin, because the GABA-ergic nervous system could be involved in MJD.
Insights
New quinolone antibiotics like fleroxacin can cause seizures and unconsciousness by blocking GABA receptors. A patient with Machado-Joseph disease experienced encephalopathy after fleroxacin, suggesting a potential predisposition.
Area of Science:
- Neuroscience
- Pharmacology
- Genetics
Background:
- New quinolone antibiotics are associated with adverse central nervous system effects, including seizures and unconsciousness.
- A known pathomechanism involves the blockade of gamma-aminobutyric acid (GABA) receptors in the central nervous system (CNS).
Observation:
- A 48-year-old female patient diagnosed with Machado-Joseph disease (MJD) developed encephalopathy following administration of the quinolone antibiotic, fleroxacin.
- She experienced unconsciousness after three days of fleroxacin (200mg/day), with electroencephalogram (EEG) revealing diffuse slow waves.
Findings:
- Discontinuation of fleroxacin led to the patient regaining consciousness within a day, and EEG abnormalities gradually resolved.
- Serum and cerebrospinal fluid concentrations of fleroxacin were within normal limits, ruling out drug accumulation as the cause.
Implications:
- Patients with Machado-Joseph disease may have an increased susceptibility to developing fleroxacin-induced encephalopathy.
- The involvement of the GABA-ergic nervous system in MJD could explain this heightened risk, highlighting the need for cautious fleroxacin use in such patients.