Antibiotic-associated encephalopathy induced by cefmetazole in a hemodialysis patient: Case report

IF 1.7 4区医学 Q3 INFECTIOUS DISEASES

Journal of Infection and Chemotherapy Pub Date : 2026-01-01 Epub Date: 2025-12-04 DOI:10.1016/j.jiac.2025.102882

Toshiyuki Nakanishi , Taku Harada , Satoshi Kutsuna

{"title":"Antibiotic-associated encephalopathy induced by cefmetazole in a hemodialysis patient: Case report","authors":"Toshiyuki Nakanishi , Taku Harada , Satoshi Kutsuna","doi":"10.1016/j.jiac.2025.102882","DOIUrl":null,"url":null,"abstract":"<div><div>Antibiotic-associated encephalopathy (AAE) is a rare but significant neurological complication of β-lactam antibiotics, particularly in patients with renal impairment. While cefepime, ceftazidime, and ceftriaxone are well-documented causes, cefmetazole (CMZ) has not been widely recognized for neurotoxicity. We report an 82-year-old Japanese man with end-stage renal disease on chronic hemodialysis who developed altered mental status and myoclonus five days after starting intravenous CMZ for prostatic abscess. Electroencephalography (EEG) revealed triphasic waves consistent with non-convulsive status epilepticus. Neuroimaging and cerebrospinal fluid analysis showed no evidence of infection or stroke. Symptoms resolved within 48 hours of CMZ discontinuation. A Naranjo score of 5 supported a diagnosis of CMZ-induced AAE. This case underscores the potential neurotoxicity of CMZ and emphasizes the importance of early recognition of AAE in patients with renal dysfunction.</div></div>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":"32 1","pages":"Article 102882"},"PeriodicalIF":1.7000,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Infection and Chemotherapy","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1341321X25002806","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/12/4 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"INFECTIOUS DISEASES","Score":null,"Total":0}

引用次数: 0

Abstract

Antibiotic-associated encephalopathy (AAE) is a rare but significant neurological complication of β-lactam antibiotics, particularly in patients with renal impairment. While cefepime, ceftazidime, and ceftriaxone are well-documented causes, cefmetazole (CMZ) has not been widely recognized for neurotoxicity. We report an 82-year-old Japanese man with end-stage renal disease on chronic hemodialysis who developed altered mental status and myoclonus five days after starting intravenous CMZ for prostatic abscess. Electroencephalography (EEG) revealed triphasic waves consistent with non-convulsive status epilepticus. Neuroimaging and cerebrospinal fluid analysis showed no evidence of infection or stroke. Symptoms resolved within 48 hours of CMZ discontinuation. A Naranjo score of 5 supported a diagnosis of CMZ-induced AAE. This case underscores the potential neurotoxicity of CMZ and emphasizes the importance of early recognition of AAE in patients with renal dysfunction.

查看原文本刊更多论文

头孢美唑致血液透析患者抗生素相关性脑病1例报告。

抗生素相关性脑病（AAE）是一种罕见但显著的β-内酰胺类抗生素神经系统并发症，尤其是肾损害患者。虽然头孢吡肟、头孢他啶和头孢曲松是有充分证据证明的原因，但头孢美唑（CMZ）尚未被广泛认为具有神经毒性。我们报告一名82岁日本男性慢性血液透析终末期肾脏疾病患者，在开始静脉注射CMZ治疗前列腺脓肿5天后出现精神状态改变和肌阵挛。脑电图显示三相波符合非惊厥性癫痫持续状态。神经影像学和脑脊液分析显示没有感染或中风的证据。停用CMZ后48小时内症状消失。Naranjo评分为5分支持cmz诱导的AAE的诊断。本病例强调了CMZ潜在的神经毒性，并强调了肾功能不全患者早期识别AAE的重要性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Journal of Infection and Chemotherapy INFECTIOUS DISEASES-PHARMACOLOGY & PHARMACY

CiteScore

4.10

自引率

4.50%

发文量

303

审稿时长

47 days

期刊介绍： The Journal of Infection and Chemotherapy (JIC) — official journal of the Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases — welcomes original papers, laboratory or clinical, as well as case reports, notes, committee reports, surveillance and guidelines from all parts of the world on all aspects of chemotherapy, covering the pathogenesis, diagnosis, treatment, and control of infection, including treatment with anticancer drugs. Experimental studies on animal models and pharmacokinetics, and reports on epidemiology and clinical trials are particularly welcome.