Ceftriaxone encephalopathy in a very elderly dialysis patient

Ceftriaxone is widely used clinically but it can potentially cause ceftriaxone encephalopathy in individuals who are on dialysis. We describe ceftriaxone encephalopathy in a dialysis patient. The 87-year-old Japanese woman had a 9-year dialysis history. She was admitted to our department with right subcostal pain and lower back pain and was diagnosed with renal cyst hemorrhage and infection. Post-admission, we treated her with ceftriaxone (CTRX) 2 g/day and bed rest, which improved her symptoms. On the 7th hospitalization day, she began to exhibit incoherent speech and unresponsiveness; by day 10, her consciousness level had decreased to grade III and myoclonus appeared. Brain MRI and a cerebrospinal fluid examination ruled out cerebrovascular disease and encephalitis. EEG showed triphasic waves predominantly in the frontal lobe. Suspecting ceftriaxone encephalopathy, we switched the antibiotic to cefazolin 1 g/day. By day 12, the myoclonus decreased and the patient was able to communicate. By day 14, her consciousness level had improved to her admission level. We treated ceftriaxone encephalopathy in a dialysis patient. Although CTRX is generally thought to not require dose reduction in patients with renal failure (due to its hepatic excretion), caution is necessary as overdosage in dialysis patients can lead to myoclonus and encephalopathy.