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Case report
Negative myoclonus as the leading symptom in acute cefepime neurotoxicity
  1. Philipp Zimmermann1,
  2. Dominik Camenzind1,
  3. Jürg Hans Beer1 and
  4. Alexander Andrea Tarnutzer2,3
  1. 1Internal Medicine, Kantonsspital Baden, Baden, Switzerland
  2. 2Neurology, Kantonsspital Baden, Baden, Switzerland
  3. 3University of Zurich Faculty of Medicine, Zürich, Switzerland
  1. Correspondence to Dr Alexander Andrea Tarnutzer; atarnutzer{at}gmail.com

Abstract

An 86-year-old woman was diagnosed with hospital-acquired pneumonia with Pseudomonas aeruginosa 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.

  • neurology (drugs and medicines)
  • movement disorders (other than Parkinsons)

https://doi.org/10.1136/bcr-2020-239744

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    Footnotes

    • Contributors PZ was involved in the treatment of the patient, was critically involved in the diagnosis, drafted the manuscript and approved the final version. DC critically edited the manuscript for content and approved the final version. JHB was involved in the treatment of the patient, critically edited the manuscript for content and approved the final version. AAT supervised the treatment of the patient, was critically involved in the diagnosis, critically edited the manuscript for content and approved the final version.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer-reviewed.