Choreoathetosis Is a Possible Adverse Event of a Commonly Used Antibiotic

Sathirapanya, Pornchai

doi:10.1159/000472148

Cited by 5 publications

(4 citation statements)

References 13 publications

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“…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.…”

Section: Discussionmentioning

confidence: 99%

“…Ceftriaxone-related adverse neurological effects are uncommon to very rare and mostly mild (dizziness, headache, ataxia, paresthesia) 1. However, multiple case reports2–21 and a case series from a French pharmacovigilance database22 have been published on more severe reactions, notably encephalopathy, trouble of consciousness and choreoathetosis. With ceftriaxone being one of the most commonly used parenteral antibiotics worldwide23, there is a possibility that many more cases of these severe adverse reactions are not readily recognised or may be confused with common delirium.…”

Section: Introductionmentioning

confidence: 99%

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

Zarauskas,

Rodrigues,

Alvarez

2024

BMJ Case Rep

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Ceftriaxone-induced encephalopathy is an exceptionally rare adverse effect of this commonly used cephalosporin and is generally observed in patients undergoing haemodialysis or suffering from severe renal failure. We present a case of a fit woman in her mid-80s with a normal renal function who developed severe fluctuating neurological symptoms (aphasia, loss of contact, chorea-like tongue movements) while being treated with ceftriaxone for a urinary tract infection with bacteraemia. The symptoms began on day 4 of treatment and an adverse drug reaction was suspected on day 7, after exhaustive investigations failed to reveal another cause. A complete recovery was observed 3 days after discontinuing ceftriaxone. Our case highlights the need to consider the diagnosis of ceftriaxone encephalopathy, even if the traditional risk factors are lacking. In this article, we also provide a brief overview of the pathophysiology as well as a literature review concerning the subject.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Zarauskas,

Rodrigues,

Alvarez

2024

BMJ Case Rep

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“…Drug-induced movement disorder with chorea is usually related to psychotic patients treated with neuroleptics and parkinsonian patients in long-term treatment with levodopa. Ceftriaxone is scarcely included due to the adverse effect [9]. Several case reports of ceftriaxone-induced choreoathetosis in ESRD patients by Sato et al were identified [10].…”

Section: Discussionmentioning

confidence: 99%

Reversible Choreoathetosis in a Patient with End-stage Renal Disease from Administration of Ceftriaxone

Tan¹,

Tun²

2019

Cureus

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A wide spectrum of neurological manifestations may be induced in patients with impaired renal function when receiving beta-lactam antibiotics due to the altered pharmacokinetics. Beta-lactam antibiotics is commonly chosen for treatment in patients with end-stage renal disease due to its good penetration into the cerebrospinal fluid and long half-life.Here, we present a case of a 73-year-old Malay lady with end-stage renal disease who was admitted for treatment of gastroenteritis. She presented with acute onset of diarrhoea and vomiting for two days. She was febrile during admission and was prescribed intravenous ceftriaxone 2 grams daily for coverage of bacterial gastroenteritis. Among the investigations done, white cell count were raised together with the C-reactive protein. Stool and blood cultures were also sent for further investigations. Over a three-day period, her general condition improved and she was discharged home. The onset of clinical manifestation of choreoathetosis was noticed by her caregiver on the same day of discharge. She was brought back to the emergency department and was readmitted for further workup of the new presenting complain of abnormal movement and disorientation. Haemodialysis was arranged and immediately commenced during her admission. The renal nurses reported that her neurological symptoms were noticeably improved after completion of the initial dialysis without any treatment.Ceftriaxone including other beta lactam antibiotics penetrates the blood-brain barrier and induces glutamate in excess in the striatum and cerebral cortex, resulting in neurological hyper excitability disorders despite appropriate renal adjusted dosage for end-stage renal disease patients on haemodialysis.

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“…Choreoathetosis in our patient may have been consequent to off-target pharmacology which has been proposed as an idiosyncratic mechanism in many unusual central nervous system adverse drug reactions [ 18 ]. In this regard, previous rare reports on drug-induced movement disorders highlight possible roles of imbalanced gamma-aminobutyric acid (GABA) receptor activity, cytokine release, and excessive glutamate which may contribute to altered excitatory and inhibitory cortical and subcortical motor control pathways [ 20 ]. Even though these suggestions and the chemical properties of a drug may explain the onset of movement disorders, the underlying patient factors that contribute in individual susceptibility to such rare drug-induced movement disorders are generally poorly elucidated.…”

Section: Discussionmentioning

confidence: 99%

Choreoathetosis – an unusual adverse effect of dihydroartemisinin-piperaquine: a case report

Kadia¹,

Morfaw²,

Simo

2017

J Med Case Reports

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BackgroundDihydroartemisinin-piperaquine is a combination of dihydroartemisinin and piperaquine which is highly effective in the treatment of uncomplicated falciparum malaria. Its adverse effects are generally tolerable and temporary. Choreoathetosis, an involuntary movement disorder characterized by continuous irregular twisting of the body, is not a documented adverse effect of this medication.Case presentationA 41-year-old Cameroonian man of black African ethnicity was brought to our primary care hospital because over the previous 6 hours he had been experiencing involuntary twisting movements of his body and he no longer had control of his limbs. Earlier that day, he had been prescribed an appropriate dose of dihydroartemisinin-piperaquine in our hospital. The abnormal movements started approximately 3 hours after ingesting the first dose of the drug. The review of systems and his past history were unremarkable. On clinical examination, he was conscious and oriented but was unsteady and displayed continuous generalized irregular twisting movements combined with abrupt low amplitude flinging of his limbs. Dihydroartemisinin-piperaquine-induced generalized choreoathetosis was diagnosed. He was sedated with diazepam and dihydroartemisinin-piperaquine was discontinued. The antimalarial drug was substituted with artemether-lumefantrine combination. The clinical progress was good and he was discharged home after 72 hours. No further abnormalities were noted during 7 months of follow-up.ConclusionAlthough dihydroartemisinin-piperaquine is increasingly popular as a well-tolerated/efficacious antimalarial drug, clinicians must note the rare possibility of choreoathetosis as an adverse effect of this medication and educate patients accordingly.

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Choreoathetosis Is a Possible Adverse Event of a Commonly Used Antibiotic

Cited by 5 publications

References 13 publications

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

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

Reversible Choreoathetosis in a Patient with End-stage Renal Disease from Administration of Ceftriaxone

Choreoathetosis – an unusual adverse effect of dihydroartemisinin-piperaquine: a case report

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