A Case of Hemiballism as a Rare Side Effect of Ciprofloxacin in a Patient with Liver Cirrhosis

Kim, Su Hyun; Jeong, Sook‐Hyang; Kim, Jin-Wook; Lee, Sang Hyub; Kim, Jong Min

doi:10.1159/000218098

Cited by 10 publications

(5 citation statements)

References 37 publications

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“…A total of 45 reports containing 51 cases who developed MDs secondary to FQNs from 16 countries were reported (Supplementary Material S2) [ 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 ]. The origin was Asian in 19 individuals, North American in 16, European in 14, and Australian in 2.…”

Section: Resultsmentioning

confidence: 99%

“…The clinical presentations of DKN were orofacial [ 27 ], generalized chorea [ 30 ], hemichorea [ 41 ], and choreoathetosis [ 45 ]. Pau Pastor and colleagues reported the first case of orofacial DKN secondary to ciprofloxacin [ 27 ].…”

Section: Discussionmentioning

confidence: 99%

“…The following supporting information can be downloaded at: , Supplementary Material S1: FreeText and MeSH search terms in the US National Library of Medicine; Supplementary Material S2: Clinical reports of fluoroquinolone (FQN)-associated movement disorder (MD). References [ 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 ] are cited in Supplementary.…”

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Fluoroquinolone-Associated Movement Disorder: A Literature Review

Rissardo

Caprara

2023

Medicines

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Background: Fluoroquinolones (FQNs) are related to several central nervous system side effects. This review aims to evaluate the clinical-epidemiological profile, pathophysiological mechanisms, and management of FQNs-associated movement disorders (MDs). Methods: Two reviewers identified and assessed relevant reports in six databases without language restriction between 1988 and 2022. Results: A total of 45 reports containing 51 cases who developed MDs secondary to FQNs were reported. The MDs included 25 myoclonus, 13 dyskinesias, 7 dystonias, 2 cerebellar syndromes, 1 ataxia, 1 tic, and 2 undefined cases. The FQNs reported were ciprofloxacin, ofloxacin, gatifloxacin, moxifloxacin, levofloxacin, gemifloxacin, and pefloxacin. The mean and median age were 64.54 (SD: 15.45) and 67 years (range: 25–87 years). The predominant sex was male (54.16%). The mean and median time of MD onset were 6.02 (SD: 10.87) and 3 days (range: 1–68 days). The mean and median recovery time after MD treatment was 5.71 (SD: 9.01) and 3 days (range: 1–56 days). A complete recovery was achieved within one week of drug withdrawal in 80.95% of the patients. Overall, 95.83% of the individuals fully recovered after management. Conclusions: Future cases need to describe the long-term follow-up of the individuals. Additionally, FQN-induced myoclonus should include electrodiagnostic studies.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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Fluoroquinolone-Associated Movement Disorder: A Literature Review

Rissardo

Caprara

2023

Medicines

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“…In addition to ADRs affecting the joints, tendons and QT prolongation, ciprofl oxacin causes a wide spectrum of neuro-psychiatric ADRs, i.e. confusion, headache, organic psychosis, manic episodes, drowsiness, vertigo, depression and even seizures (2)(3)(4)(5)(6)(7)(8)(9)(10). Neuro-psychiatric ADRs may be linked to larger doses (7,8), kidney or liver dysfunction (3,(6)(7)(8) and a history of disease that affects the central nervous system (CNS) (7,9).…”

Section: Introductionmentioning

confidence: 99%

The frequency of, and predisposing risk factors for, ciprofloxacin-induced neuro-psychiatric adverse drug reactions

HARTINGER,

DVORACKOVA,

MYSLIVECEK

et al. 2023

BLL

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OBJECTIVES: Ciprofl oxacin induces rare neuro-psychiatric adverse drug reactions (ADRs) that are, as yet, not possible to predict due to unknown predisposition factors. BACKGROUND: The aim of the analysis was to assess the frequency of neuro-psychiatric ADRs and to identify potential risk factors that predisposed patients to ciprofl oxacin neurotoxicity. METHODS: This observational retrospective study involved the evaluation of the medical records of patients in the Nephrology department and 3 rd Internal Clinic of the General University Hospital in Prague. RESULTS: The overall incidence of neurological ADRs was 3.6 %. No neurological ADRs developed in patients aged less than 70 years. The covariates that were signifi cantly more prevalent in the patients who developed neuropsychiatric ADRs were as follows: higher age, a history of neuropsychiatric disorders and the use of anticonvulsants. The administration of drugs from other ATC groups, gender, weight, body mass index, body surface area, renal functions, level of C-reactive protein at the beginning of treatment and the total daily dose/kg did not differ signifi cantly between the two groups. CONCLUSION: Ciprofl oxacin neuropsychiatric ADRs are more frequent in older patients with a history of neurologic or psychiatric disorders. No other tested covariates were proven to predispose patients to neuropsychiatric ADRs during treatment with ciprofl oxacin (Tab. 2, Ref. 20).

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“…Other abnormal movements related to CAHD include hemiballism [ 4 ], extraocular muscle dystonia [ 5 ], orofacial dyskinesia [ 6 ], and tremors that can be intentional, postural, or rest tremors.1 However, tremors, ataxia and other movement disorders in chronic liver disease are also influenced by many factors such as alcohol [ 7 ], medications [ 4 ], and metabolic imbalances [ 8 ]. Furthermore, there is one case report of recurrent neurological deficits and Parkinsonism in a cirrhotic patient following liver transplantation [ 9 ].…”

mentioning

confidence: 99%

Movement Disorders in Non-Wilsonian Hepatic Cirrhotic Patients: The Subgroup Analysis of Various Phenotypes and Associated Risk Factors

Methawasin¹,

Chonmaitree

Wongjitrat

et al. 2016

JMD

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ObjectiveThe aim of this subgroup analysis was to identify the risk factors associated with the development of various movement disorder phenotypes.MethodsEighty-three non-Wilsonian cirrhotic patients with abnormal movements were allocated into the following groups: intention tremor, bradykinesia, Parkinsonism, and abnormal ocular movements. These movement types were considered the primary outcomes as there was a sufficient sample size. Researchers took into consideration the gender, etiologies of cirrhosis, cirrhosis-related complications, hepatic encephalopathy, medical illness, and some neurological deficits as potential factors associated with these movement disorders.ResultsThe male gender (p = 0.002) and alcoholic cirrhosis (p = 0.005) were significant factors for the prevalence of intention tremors. In bradykinesia, hepatic encephalopathy was highly statistically significant (p < 0.001), and females more commonly developed bradykinesia (p = 0.04). The Parkinsonism features in this study were confounded by hyperlipidemia (p = 0.04) and motor or sensory deficits (p = 0.02). Jerky pursuits and a horizontal nystagmus were detected. Jerky pursuits were significantly related to hepatic encephalopathy (p = 0.003) and bradykinesia, but there were no factors associated with the prevalence of nystagmus other than an intention tremor.ConclusionsThe association of alcoholic cirrhosis with the development of intention tremor indicates that the persistent cerebellar malfunction in cirrhotic patients is due to alcohol toxicity. The slowness of finger tapping and jerky pursuit eye movements are significantly associated with hepatic encephalopathy. Thus, further studies are needed to evaluate the diagnostic value of these two signs for an early detection of mild hepatic encephalopathy.

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A Case of Hemiballism as a Rare Side Effect of Ciprofloxacin in a Patient with Liver Cirrhosis

Cited by 10 publications

References 37 publications

Fluoroquinolone-Associated Movement Disorder: A Literature Review

Fluoroquinolone-Associated Movement Disorder: A Literature Review

The frequency of, and predisposing risk factors for, ciprofloxacin-induced neuro-psychiatric adverse drug reactions

Movement Disorders in Non-Wilsonian Hepatic Cirrhotic Patients: The Subgroup Analysis of Various Phenotypes and Associated Risk Factors

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