Ertapenem-Associated Neurotoxicity in a Patient With Chronic Kidney Disease and Hypothyroidism: A Case Report

Carbapenems are broad-spectrum antibiotics used to treat infections caused by multidrug-resistant organisms and are associated with neurotoxicity, especially in high-risk groups. Although ertapenem generally has a lower risk of seizures, factors such as advanced age, pre-existing neurological conditions, renal impairment, and hypoalbuminemia can raise the likelihood of adverse effects. We report a 92-year-old female with multiple comorbidities, including hypothyroidism, dementia, well-controlled post-stroke epilepsy, and chronic kidney disease, who developed a focal impaired awareness seizure on day 3 of IV ertapenem treatment for a multidrug-resistant urinary tract infection, despite prior tolerance to intravenous ertapenem, with complete resolution after discontinuation of IV ertapenem. This case highlights that ertapenem can be a potential precipitating factor for neurotoxicity in patients with a history of stable epilepsy and tolerance to the drug, particularly in those with advanced age and chronic kidney disease. Early recognition and discontinuation of the antibiotic are essential, as neurological symptoms are typically reversible.