Delayed-Onset Cefepime Neurotoxicity in a Patient With Epilepsy and ESRD

Area of Science:

• Neurology
• Nephrology
• Infectious Diseases

Background:

• Cefepime is a commonly used antibiotic.
• Patients with renal impairment are at higher risk for cefepime-induced neurotoxicity (CIN).
• CIN can present with diverse neurological symptoms, complicating diagnosis in patients with comorbidities.

Purpose of the Study:

• To report a case of cefepime-induced neurotoxicity in a patient with end-stage renal disease and epilepsy.
• To highlight the diagnostic challenges and management strategies for CIN in complex patients.

Main Methods:

• Case report of a 42-year-old woman with ESRD on hemodialysis, SLE, and epilepsy.
• Patient presented with recurrent seizures during cefepime therapy for chronic Pseudomonas aeruginosa bacteremia.
• Diagnosis was supported by EEG findings and elevated serum cefepime levels.

Main Results:

• The patient experienced recurrent seizures despite therapeutic clobazam levels and stable metabolic parameters.
• Cefepime discontinuation and transition to ceftazidime led to seizure resolution.
• The patient remained seizure-free throughout the remainder of hospitalization.

Conclusions:

• Cefepime neurotoxicity poses a diagnostic challenge in patients with renal impairment and comorbidities, especially epilepsy.
• High clinical suspicion, EEG, and drug level monitoring are crucial for diagnosing CIN.
• Early discontinuation of cefepime is essential for managing neurotoxicity.