Htay Wyut Yi, Aung Wai Lin, Phyu Wah Pwint
Geriatrics, West Middlesex University Hospital, London, GBR.
General Medicine, West Middlesex University Hospital, London, GBR.
Cureus. 2025 May 4;17(5):e83457. doi: 10.7759/cureus.83457. eCollection 2025 May.
Ertapenem-induced neurotoxicity is a rare, often underreported side effect, primarily seen in elderly patients with impaired renal function. We report the case of an 87-year-old woman with a history of chronic kidney disease (CKD) and bilateral hydronephrosis, who presented with acute neurological symptoms, including left-sided weakness and slurred speech. Prior to this presentation, she had been treated for a left-sided nephrostomy site infection and left-sided perinephric collection with intravenous ertapenem at an ambulatory emergency care (AEC) center. An initial computed tomography (CT) scan of the brain showed no acute changes, but we treated her for a possible stroke while awaiting a magnetic resonance imaging (MRI) scan of the brain and continued intravenous ertapenem for the associated urological infection. However, the patient's condition continued to deteriorate, with the onset of further neurological symptoms, such as left-sided sensory deficits and constant myoclonic movements. An MRI scan of the brain showed no significant changes. The patient was diagnosed with ertapenem-induced neurotoxicity. We discontinued the antibiotic and switched to meropenem. Her neurological symptoms gradually improved and subsided within a week of stopping ertapenem. This case highlights the importance of clinical suspicion of ertapenem-induced neurotoxicity in elderly and frail patients with reduced renal function who present with unexplained neurological symptoms. Prompt recognition of the condition facilitates accurate diagnosis and management. Treatment is simple and involves discontinuing the offending drug, leading to favorable outcomes.
厄他培南诱发的神经毒性是一种罕见且常未被报告的副作用，主要见于肾功能受损的老年患者。我们报告了一例87岁女性病例，她有慢性肾脏病（CKD）和双侧肾积水病史，出现了急性神经症状，包括左侧肢体无力和言语不清。在此次发病前，她在门诊急救中心因左侧肾造瘘口感染和左侧肾周积液接受了静脉注射厄他培南治疗。最初的脑部计算机断层扫描（CT）未显示急性变化，但在等待脑部磁共振成像（MRI）扫描期间，我们按可能的中风对她进行了治疗，并继续静脉注射厄他培南以治疗相关的泌尿系统感染。然而，患者的病情持续恶化，出现了进一步的神经症状，如左侧感觉障碍和持续性肌阵挛运动。脑部MRI扫描未显示明显变化。该患者被诊断为厄他培南诱发的神经毒性。我们停用了抗生素，改用美罗培南。她的神经症状在停用厄他培南一周内逐渐改善并消退。该病例强调了对于肾功能减退且出现不明原因神经症状的老年体弱患者，临床怀疑厄他培南诱发神经毒性的重要性。及时识别该病症有助于准确诊断和管理。治疗简单，包括停用致病药物，可带来良好的治疗效果。
