Ceftriaxone-induced encephalopathy in a patient with multicentric glioma

Abstract

Background: Ceftriaxone is a commonly used antibiotic in a wide range of local and systemic infections. Encephalopathy is a rare complication of ceftriaxone, often seen in older adults and those with renal insufficiency. Case Description: A 73-year-old lady with prior history of hypertension and dyslipidemia presented with the complaints of slurred speech, gait imbalance, nocturnal vomiting, and progressively worsening headache. A magnetic resonance imaging of the brain revealed two intracerebral lesions involving the right frontal and temporal lobes, suggestive of multicentric glioma. She underwent craniotomy and excision of these lesions. The biopsy was reported as intra-axial tumors with features suggestive of the WHO Grade IV glioma. Postoperatively, she did not wake up. An electroencephalogram demonstrated triphasic waves suggestive of encephalopathy. The probable diagnosis of ceftriaxone-induced encephalopathy was made after ruling out other causes of delayed awakening after surgery. Ceftriaxone was discontinued and the patient improved within 2 days of withdrawal of ceftriaxone. Conclusion: Drug-induced encephalopathy should be considered in the differential diagnosis of patients with delayed awakening after surgery. Discontinuation of the drug leads to the recovery of these patients.

Ceftriaxone-induced encephalopathy in a patient with a normal renal function

“…We did a literature review on PubMed in April 2023 without a time limit and identified 15 case reports,4 6–9 11–13 15–18 20 21 26 7 small case series2 3 5 10 14 19 27 and 2 pharmacovigilance database analysis22 28 discussing serious neurological effects of ceftriaxone in humans.…”

“…Please note that we decided to exclude one case report because of possible confounding factors not detailed in the report 26 and one case series because of radically different patient descriptions in the written text and the supplied chart. 27 …”