Cefepime Induced Neurotoxicity Mimicking Clinical Presentation of Left Middle Cerebral Artery Infarction: A Case Report and Review of Literature

Cefepime is a widely used antibiotic which was known to have neurotoxicity resulted from its ability to cross the blood-brain barrier and a wide variety of symptoms had been documented. Here we reported a case of Cefepime induced neurotoxicity with rare presentation. The aim of this study was to improve the knowledge of this condition. A 89-year-old female with a history of ESRD (end stage renal disease) and superimposed acute cholecystitis was treated with Cefepime. She developed the symptoms of global aphasia, right hemiplegia, leftward eye deviation and abnormal plantar reflex at right foot, which resembled acute ischemic stroke at left MCA (middle cerebral artery), on the fourth day of Cefepime treatment. There was no evidence of acute infarction in MRI (magnetic resonance imaging) of brain and EEG (electroencephalography) revealed NCSE (nonconvulsive status epilepticus). NCSE was suspected to be attributed to Cefepime-induced neurotoxicity. The patient's main risk factors were decreased renal clearance and incorrect dosing. Conslusion: Cefepime-induced neurotoxicity should be suspected in patients who developed neurologic symptoms after the administration of Cefepime. Emergent image study for excluding more commonly seen or critical etiologies and further evaluation with EEG were necessary. For those patients who have risk factors for Cefepime neurotoxicity, such as ESRD, TDM (therapeutic drug monitoring) may be useful in providing close monitoring and preventing adverse effects associated with Cefepime treatment. Keyword: Cefepime, acute ischemic stroke, aphaia, nonconvulsive status epilepticus.