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Piperacillin/tazobactam-induced neurotoxicity in a hemodialysis patient: a case report
Precil Diego M M Neves1, Fernanda M Freitas, Christiane A Kojima
1Internal Medicine Department, University of São Paulo State, São Paulo, Brazil.
Abstract:
Antibiotics are potentially a cause of neurotoxicity in dialysis patients, the most common are the beta-lactams as ceftazidime and cefepime, and few cases have been reported after piperacillin/tazobactam use. This report presents a case of a hypertensive and diabetic 67-year-old woman in regular hemodialysis, which previously had a stroke. She was hospitalized presenting pneumonia, which was initially treated with cefepime. Two days after treatment, she presented dysarthria, left hemiparesis, ataxia, and IX and X cranial nerves paresis. Computed tomography showed no acute lesions and cefepime neurotoxicity was hypothesized, and the antibiotic was replaced by piperacillin/tazobactam. The neurologic signs disappeared; however, 4 days after with piperacillin/tazobactam treatment, the neurological manifestations returned. A new computed tomography showed no new lesions, and the second antibiotic regimen withdrawn. After two hemodialysis sessions, the patient completely recovered from neurological manifestations. The patient presented sequentially neurotoxicity caused by two beta-lactams antibiotics. This report meant to alert clinicians that these antibiotics have dangerous neurological effects in chronic kidney disease patients.
Insights
Beta-lactam antibiotics like cefepime and piperacillin/tazobactam can cause neurotoxicity in dialysis patients. This case highlights sequential antibiotic-induced neurological events in a patient with chronic kidney disease.
Area of Science:
- Nephrology
- Neurology
- Pharmacology
Background:
- Antibiotic-induced neurotoxicity is a recognized complication, particularly in patients with impaired renal function.
- Beta-lactam antibiotics, including cephalosporins and penicillins, are frequently implicated.
- Dialysis patients are at increased risk due to altered drug clearance and potential blood-brain barrier dysfunction.
Observation:
- A 67-year-old female on hemodialysis with a history of stroke presented with pneumonia.
- Initial treatment with cefepime led to acute neurological deficits including dysarthria, hemiparesis, and cranial nerve palsies.
- Neurological symptoms recurred upon switching to piperacillin/tazobactam, resolving only after antibiotic withdrawal and hemodialysis.
Findings:
- The patient experienced sequential neurotoxicity attributed to two different beta-lactam antibiotics.
- Cerebral imaging did not reveal acute lesions, supporting a drug-induced etiology.
- Complete neurological recovery was achieved after cessation of antibiotics and completion of hemodialysis sessions.
Implications:
- This case underscores the potential for severe neurotoxicity from commonly used beta-lactam antibiotics in chronic kidney disease patients undergoing dialysis.
- Clinicians should maintain a high index of suspicion for antibiotic-induced neurotoxicity in this vulnerable population.
- Careful antibiotic selection and monitoring are crucial to prevent adverse neurological outcomes in dialysis patients.
