Department of Internal Medicine, SCL Health, Denver, Colorado, USA
Department of Medicine, University of Colorado, Denver, Colorado, USA.
BMJ Case Rep. 2020 Jun 1;13(6):e231875. doi: 10.1136/bcr-2019-231875.
Neurotoxicity is an unusual side effect of carbapenems, and it has been reported most commonly presenting as seizures, encephalopathy and hallucinations. Ertapenem neurotoxicity most classically presents as seizures in patients with end-stage renal disease (estimated glomerular filtration rate (eGFR) <30 mL/min/1.73 m). We present a patient with a baseline eGFR of 30-59 mL/min/1.73 m with acute kidney injury who developed non-seizure neurotoxicity after ertapenem exposure. This patient is a middle-aged Caucasian man who received intravenous ertapenem for treatment of empyema. Although the empyema improved, he developed delirium beginning on day 7 of ertapenem. The delirium progressed to constant agitation and visual hallucinations requiring transfer to the intensive care unit with eventual intubation for airway protection. No improvement in mental status was observed with cessation of other medications. Ertapenem was discontinued and within 24 hours, he was extubated, and his mental status returned to baseline. He was discharged from the hospital the following day. The timely resolution after ertapenem discontinuation makes ertapenem-induced encephalopathy the most likely explanation for this patient's course.
神经毒性是碳青霉烯类药物的一种不常见的副作用，最常报道的表现为癫痫、脑病和幻觉。厄他培南神经毒性最典型的表现为终末期肾病（估计肾小球滤过率[eGFR]＜30 mL/min/1.73 m ）患者的癫痫发作。我们报告了一例基线 eGFR 为 30-59 mL/min/1.73 m、急性肾损伤的患者，在使用厄他培南后发生非癫痫性神经毒性。该患者为中年白人男性，因脓胸接受静脉注射厄他培南治疗。尽管脓胸有所改善，但他在厄他培南治疗的第 7 天开始出现意识模糊。意识模糊进展为持续躁动和视幻觉，需要转入重症监护病房，最终进行气管插管以保护气道。停止其他药物后，精神状态没有改善。停止使用厄他培南后 24 小时内，患者拔管，精神状态恢复基线水平。他第二天出院。厄他培南停药后及时缓解，使厄他培南诱导的脑病最有可能解释该患者的病程。
