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A6867 - Cefepime-Induced Non-Convulsive Status Epilepticus: A Rare and Treatable Delirium
Author Block: M. Naddour1, M. Kalani2, M. Balaan2; 1Allegheny Health Network, Pittsburgh, PA, United States, 2Allegheny General Hospital,, Pittsburgh, PA, United States.
Introduction Cefepime-induced neurotoxcitiy is an uncommon phenomenon, and non-convulsive status epilepticus (NCSE) is a rare presentation. Here in, we present a case of cefepime-induced NCSE that resolved with hemodialysis Case 61-year-old female with history of osteosarcoma of the left distal femur, status post resection with recent left prosthetic joint infection presented with altered mental status. 33 days prior to admission, she was evaluated for suspected left knee prosthetic joint infection. Cultures were positive for pseudomonas and patient was started on continuous cefepime for 6 weeks. Patient had intractable nausea and vomiting, and therefore presented to the emergency department. She was found to be confused, aphasic and labs showed acute kidney injury however there was no indication for hemodialysis. CT head was negative. On hospital day 2, patient was found unresponsive, and was transferred to the medical ICU. EEG showed high-voltage triphasic waveforms in a rhythmic fashion, consistent with NCSE. Patient was diagnosed with cefepime-induced neurotoxicity, cefepime was discontinued and the patient underwent hemodialysis. On hospital day 4, patient’s mental status returned to baseline, and had normal EEG waveforms. The patient was not discharged on any antiepileptic medications and her neurological exam was completely intact on discharge. Discussion Cefepime is a fourth-generation cephalosporin with broad-spectrum coverage of gram-positive and negative bacteria. Cefepime is predominatly excreted via kidney, therefore its half-life increases as renal function declines and may result in adverse events [1]. Cefepime-induced neurotoxicity occurs at an incidence of 1-3% [2]. Patients can present with delirium, stupor, coma, myoclonus or NCSE. Symptoms usually develop within 7 days (range, 1-24 days) after initiating cefepime treatment [2]. Risk factors include intracranial lesions, advanced age and renal failure. It is postulated that cefepime acts as a competitive antagonist of GABA-A and therefore blocks GABA-A receptor leading to decreased inhibitory activity [2]. Cefepime-induced NCSE is a rare clinical presentation of cefepime neurotoxicity, and only 60 cases have been reported in the literature [1]. Periodic sharp waves and triphasic waves are classically seen on EEG in cefepime neurotoxcity [1]. Treatment involves discontinuation of cefepime, and may require hemodialysis to eliminate the drug. Conclusion Cefepime-induced NCSE is a rare form of cefepime-induced neurotoxicity. To our knowledge, no cases are reported with patients on continuous infusion and more than 24 days after initiation of cefepime. Clinicians should consider this diagnosis and check an EEG in patients suspected to develop neurological complication