Internal Medicine, Kantonsspital Baden, Baden, Switzerland.
Neurology, Kantonsspital Baden, Baden, Switzerland
BMJ Case Rep. 2021 Apr 8;14(4):e239744. doi: 10.1136/bcr-2020-239744.
An 86-year-old woman was diagnosed with hospital-acquired pneumonia with and treated with cefepime adjusted to her renal clearance. After 4 days, she developed acute-onset negative myoclonus without signs of altered mental status. After ruling out an acute intracranial haemorrhagic or ischaemic stroke as well as other metabolic and endocrine causes of negative myoclonus, the antibiotic was switched to piperacillin/tazobactam due to a suspicion of cefepime neurotoxicity. The patient improved within 24 hours and her symptoms fully resolved within 4 days. These observations suggest a link of the negative myoclonus to acute cefepime neurotoxicity, which may occur without or with minimal alteration of mental status, thus extending its spectrum of clinical presentation.
一位 86 岁女性被诊断为医院获得性肺炎，给予调整至肾功能清除率的头孢吡肟治疗。4 天后，她突发负性肌阵挛，无精神状态改变的迹象。在排除急性颅内出血或缺血性卒中以及其他代谢和内分泌原因引起的负性肌阵挛后，由于怀疑头孢吡肟的神经毒性，将抗生素更换为哌拉西林/他唑巴坦。患者在 24 小时内改善，4 天内症状完全缓解。这些观察结果表明，负性肌阵挛与急性头孢吡肟神经毒性之间存在关联，其可能在无或仅有轻微精神状态改变的情况下发生，从而扩展了其临床表现谱。
