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Acute Encephalopathy in Multiple Sclerosis With Renal Failure: Synergistic Neurotoxicity of Baclofen and Meropenem

Bernacchia D1, Rigoni M2, Canavesi G1,2

  • 1Infectious Diseases Unit, ASST-Ovest Milanese, Legnano, Milan, Italy.

Case Reports in Infectious Diseases
|June 22, 2026
PubMed

Insights

A case study reveals acute metabolic encephalopathy in a multiple sclerosis patient due to baclofen overdose, potentially worsened by meropenem and impaired renal function. This highlights the importance of considering drug interactions in patients with altered mental status.

Area of Science:

  • Neurology
  • Pharmacology
  • Infectious Diseases

Background:

  • Multiple sclerosis (MS) is a chronic neurological disease.
  • Urinary tract infections (UTIs) are common in MS patients.
  • Acute encephalopathy can be a serious complication.

Purpose of the Study:

  • To report a clinical case of acute encephalopathy in an MS patient.
  • To investigate the potential drug interactions contributing to neurotoxicity.
  • To emphasize the importance of considering polypharmacy in complex cases.

Main Methods:

  • Clinical case presentation of a 62-year-old male with secondary progressive MS.
  • Analysis of symptoms including altered consciousness and seizures during antibiotic therapy.
  • Investigation of medication history, revealing baclofen overdose and impaired renal function.

Main Results:

  • The patient developed acute metabolic encephalopathy, initially misattributed to meropenem.
  • Baclofen overdose was identified as the primary cause.
  • A potential interaction between baclofen and meropenem neurotoxicity was suspected due to combined GABA receptor effects in renal impairment.

Conclusions:

  • Drug toxicity and interactions must be considered in patients presenting with altered mental status.
  • Polypharmacy and comorbid conditions, like impaired renal function, increase the risk of adverse drug events.
  • This case underscores the need for careful medication review, especially with muscle relaxants and antibiotics in MS patients.

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