Wadia Subeer, Tran Betty
Rush University Medical Center, Chicago, Illinois, USA.
Department of Pulmonary and Critical Care, Rush University Medical Center, Chicago, Illinois, USA.
BMJ Case Rep. 2014 Sep 8;2014:bcr2014205332. doi: 10.1136/bcr-2014-205332.
We describe a 51-year-old man who developed renal and neural toxicity after the administration of colistin. He developed respiratory apnoea, neuromuscular blockade and severe comatose encephalopathy with the lack of brainstem reflexes. After discontinuation of the antibiotic, he made a prompt recovery to his baseline neurological function. The case illustrates the importance of recognising the toxicities associated with colistin. Although recent literature details its nephrotoxicity, current data have been discordant with the rare cases of respiratory apnoea or neuromuscular blockade once cited over 30 years ago. Additionally, no cases have ever described the profound encephalopathy with lack of brainstem function described here. The awareness of colistin's potentially fatal effects must be kept in mind when administering this antibiotic. Vigilance of the encephalopathic picture can also facilitate the diagnosis of colistin-mediated neurotoxicity in a patient with altered mental status of otherwise unknown aetiology.
我们描述了一名51岁男性，其在使用黏菌素后出现了肾脏和神经毒性。他出现了呼吸暂停、神经肌肉阻滞以及严重的昏迷性脑病，且缺乏脑干反射。停用抗生素后，他迅速恢复到基线神经功能。该病例说明了认识黏菌素相关毒性的重要性。尽管近期文献详细描述了其肾毒性，但目前的数据与30多年前曾报道过的罕见呼吸暂停或神经肌肉阻滞病例不一致。此外，此前没有病例描述过此处所出现的伴有脑干功能缺失的严重脑病。在使用这种抗生素时，必须牢记黏菌素潜在的致命影响。对脑病表现保持警惕也有助于诊断病因不明、精神状态改变患者的黏菌素介导的神经毒性。
