Delusion of Worm Infestation Associated with Clarithromycin in a Patient on Peritoneal Dialysis

Delusional Infestation Induced by Piribedil Add-On in Parkinson's Disease

“…Apart from its direct dopaminergic actions at D2-like receptors, our report suggests a participation of central nervous alpha-2 drenoreceptors , most probably by indirect adrenergic and dopaminergic eff ects, in inducing symptoms of substance-induced delusional infesta-tion. Similarly, anecdotal evidence from single cases found an association of non-dopaminergic drugs with symptoms of DI, e. g., antibiotics such as clarithromycin [15] or ciprofl oxacin [16] , corticosteroids [8,17] , cannabis [18,19] , IFN alpha-b2 + ribavirin [20] , and topiramate [21] . The psychotic symptoms seen with quinolone antibiotics such as ciprofl oxacine are usually explained by anti-glutamatergic eff ects at NMDA receptors.…”

Drug-induced Delusional Infestation

“…There have been a few single reported cases of DI associated with the antimicrobial agents ciprofloxacin and clarithromycin (Table SII), both of which are known to cause psychiatric adverse effects ( 25 , 26 ). However, both reports claim to be the first to associate DI with these drugs.…”

Clinical manifestation of macrolide antibiotic toxicity in CKD and dialysis patients

“…Clarithromycin [ 16 ], and much less for erythromycin [ 17 , 18 ], have been reported to cause neurotoxicity, mostly in the form of acute delirium or psychosis. Although uncommon, visual hallucination was the predominant presenting symptom of clarithromycin-induced neurotoxicity in some patients, including both dialysis [ 19 , 20 ] and non-dialysis populations [ 21 , 22 ]. Most patients improved spontaneously upon cessation of clarithromycin.…”

“…Symptoms subsided 3 days after drug cessation. Tse et al [ 20 ] reported another case of visual hallucination in the form of delusion of worms in a 49-year-old male peritoneal dialysis patient after taking clarithromycin 250 mg three times a day for 1 week. This particular patient also had history of acyclovir-induced encephalopathy.…”