Sugiura Mieko, Shibata Koichi, Saito Satoshi, Nishimura Yoshiko, Sakura Hiroshi
Department of Internal Medicine, Tokyo Women's Medical University Medical Center East, Japan.
Intern Med. 2019 May 15;58(10):1495-1499. doi: 10.2169/internalmedicine.1619-18. Epub 2019 Feb 1.
A 64-year-old woman with no previous mental illness took a single 500 mg tablet of levofloxacin for cystitis. Two hours later, she developed psychosis with involuntary movement and severe hyperventilation with respiratory alkalosis. Cranial magnetic resonance imaging findings were unremarkable, and an electroencephalogram revealed no epileptiform discharge. Her symptoms improved on the third day after levofloxacin was discontinued. Levofloxacin-associated encephalopathy with psychotic features is a rare adverse event. Disturbance of gamma-aminobutyric acid-ergic (GABAergic) interneurons by levofloxacin may lead to hyperventilation via dysfunction of the brainstem respiratory network. Physicians should be aware of hyperventilation as an additional serious symptom of levofloxacin-associated encephalopathy in acute settings.
一名64岁既往无精神疾病的女性因膀胱炎服用了一片500毫克的左氧氟沙星。两小时后，她出现了精神病症状，伴有不自主运动和严重的通气过度及呼吸性碱中毒。头颅磁共振成像检查结果无异常，脑电图显示无癫痫样放电。停用左氧氟沙星后第三天她的症状有所改善。具有精神病特征的左氧氟沙星相关性脑病是一种罕见的不良事件。左氧氟沙星对γ-氨基丁酸能（GABA能）中间神经元的干扰可能通过脑干呼吸网络功能障碍导致通气过度。医生应意识到在急性情况下通气过度是左氧氟沙星相关性脑病的另一种严重症状。
