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Zarauskas A, Rodrigues B, Alvarez V. Ceftriaxone-induced encephalopathy in a patient with a normal renal function. BMJ Case Rep 2024; 17:e256934. [PMID: 38216159 PMCID: PMC10806959 DOI: 10.1136/bcr-2023-256934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2024] Open
Abstract
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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Affiliation(s)
- Audrius Zarauskas
- Internal Medicine, Hopital de Sion Centre Hospitalier du Valais Romand, Sion, Switzerland
| | - Bruno Rodrigues
- Internal Medicine, Hopital de Sion Centre Hospitalier du Valais Romand, Sion, Switzerland
| | - Vincent Alvarez
- Neurology, Hôpital de Sion Centre Hospitalier du Valais Romand, Sion, Switzerland
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Saft C, Burgunder JM, Dose M, Jung HH, Katzenschlager R, Priller J, Nguyen HP, Reetz K, Reilmann R, Seppi K, Landwehrmeyer GB. Differential diagnosis of chorea (guidelines of the German Neurological Society). Neurol Res Pract 2023; 5:63. [PMID: 37993913 PMCID: PMC10666412 DOI: 10.1186/s42466-023-00292-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 10/18/2023] [Indexed: 11/24/2023] Open
Abstract
INTRODUCTION Choreiform movement disorders are characterized by involuntary, rapid, irregular, and unpredictable movements of the limbs, face, neck, and trunk. These movements often initially go unnoticed by the affected individuals and may blend together with seemingly intended, random motions. Choreiform movements can occur both at rest and during voluntary movements. They typically increase in intensity with stress and physical activity and essentially cease during deep sleep stages. In particularly in advanced stages of Huntington disease (HD), choreiform hyperkinesia occurs alongside with dystonic postures of the limbs or trunk before they typically decrease in intensity. The differential diagnosis of HD can be complex. Here, the authors aim to provide guidance for the diagnostic process. This guidance was prepared for the German Neurological Society (DGN) for German-speaking countries. RECOMMENDATIONS Hereditary (inherited) and non-hereditary (non-inherited) forms of chorea can be distinguished. Therefore, the family history is crucial. However, even in conditions with autosomal-dominant transmission such as HD, unremarkable family histories do not necessarily rule out a hereditary form (e.g., in cases of early deceased or unknown parents, uncertainties in familial relationships, as well as in offspring of parents with CAG repeats in the expandable range (27-35 CAG repeats) which may display expansions into the pathogenic range). CONCLUSIONS The differential diagnosis of chorea can be challenging. This guidance prepared for the German Neurological Society (DGN) reflects the state of the art as of 2023.
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Affiliation(s)
- Carsten Saft
- Department of Neurology, St. Josef-Hospital, Huntington-Zentrum NRW, Ruhr-Universität Bochum, Bochum, Germany.
| | - Jean-Marc Burgunder
- Department of Neurology, Schweizerisches Huntington-Zentrum, Bern University, Bern, Switzerland
| | - Matthias Dose
- Kbo-Isar-Amper-Klinikum Taufkirchen/München-Ost, Munich, Germany
| | - Hans Heinrich Jung
- Department of Neurology, University Hospital Zürich, Zurich, Switzerland
| | - Regina Katzenschlager
- Department of Neurology, Karl Landsteiner Institute for Neuroimmunological and Neurodegenerative Disorders, Klinik Donaustadt, Vienna, Austria
| | - Josef Priller
- Department of Psychiatry and Psychotherapy, Klinikum Rechts der Isar, School of Medicine and Health, Technical University of Munich, Munich, Germany
- Neuropsychiatry, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Huu Phuc Nguyen
- Department of Human Genetics, Huntington-Zentrum NRW, Ruhr-Universität Bochum, Bochum, Germany
| | - Kathrin Reetz
- Department of Neurology, Euregional Huntington Centre Aachen, RWTH Aachen University Hospital, Aachen, Germany
| | - Ralf Reilmann
- George-Huntington-Institute, Muenster, Germany
- Department of Radiology, Universitaetsklinikum Muenster (UKM), Westfaelische Wilhelms-University, Muenster, Germany
- Department of Neurodegenerative Diseases and Hertie-Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany
| | - Klaus Seppi
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
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Futagi Y, Ito Y, Nakade J, Fujita A, Shimada T, Yoshida M, Takahashi Y, Kawano M, Taniguchi T, Sai Y. Ceftriaxone-induced encephalopathy in a patient with a solitary kidney. Int J Infect Dis 2022; 122:722-724. [PMID: 35843497 DOI: 10.1016/j.ijid.2022.07.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 07/08/2022] [Accepted: 07/11/2022] [Indexed: 10/17/2022] Open
Abstract
Ceftriaxone (CRO) is a long-acting third-generation cephalosporin antibiotic. We present a case of CRO-induced encephalopathy in an 84-year-old male patient with a solitary right kidney, admitted with bilateral pneumonia and right pyelonephritis. Intravenous CRO (2 g, every 24 hr) was started for the infection, but tonic-clonic seizures of the left face and left upper extremity appeared on the 8th day. To examine the relationship between CRO administration and the seizures, we measured CRO concentrations in the patients' plasma/serum and cerebrospinal fluid (CSF). The CRO concentration in blood at the onset of encephalopathy was estimated to have been approximately 60 μg/mL based on a simulation curve. We also calculated the pharmacokinetic parameters after CRO administration. The patient had about one-tenth of the total body clearance and one-third of the volume of distribution compared with healthy adults, and the elimination half-life was about 3 times longer.
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Affiliation(s)
- Yuya Futagi
- Department of Hospital Pharmacy, University Hospital, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641, Japan.
| | - Yuriko Ito
- Department of Hospital Pharmacy, University Hospital, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641, Japan
| | - Junya Nakade
- Department of Hospital Pharmacy, University Hospital, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641, Japan; Department of Infection Control and Prevention, University Hospital, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641, Japan
| | - Arimi Fujita
- Department of Hospital Pharmacy, University Hospital, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641, Japan; Department of Clinical Pharmacokinetics, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641, Japan
| | - Tsutomu Shimada
- Department of Hospital Pharmacy, University Hospital, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641, Japan; Department of Clinical Pharmacokinetics, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641, Japan
| | - Misaki Yoshida
- Department of Rheumatology, University Hospital, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641, Japan
| | - Yoshinori Takahashi
- Department of Infection Control and Prevention, University Hospital, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641, Japan; Department of Rheumatology, University Hospital, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641, Japan
| | - Mitsuhiro Kawano
- Department of Rheumatology, University Hospital, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641, Japan
| | - Takumi Taniguchi
- Intensive Care Unit, University Hospital, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641, Japan
| | - Yoshimichi Sai
- Department of Hospital Pharmacy, University Hospital, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641, Japan; Department of Clinical Pharmacokinetics, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641, Japan
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Ebihara F, Hamada Y, Kato H, Maruyama T, Kimura T. Importance and Reality of TDM for Antibiotics Not Covered by Insurance in Japan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052516. [PMID: 35270215 PMCID: PMC8909063 DOI: 10.3390/ijerph19052516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 02/18/2022] [Accepted: 02/19/2022] [Indexed: 12/10/2022]
Abstract
Under the Japanese health insurance system, medicines undergoing therapeutic drug monitoring (TDM) can be billed for medical fees if they meet the specified requirements. In Japan, TDM of vancomycin, teicoplanin, aminoglycosides, and voriconazole, which are used for the treatment of infectious diseases, is common practice. This means the levels of antibiotics are measured in-house using chromatography or other methods. In some facilities, the blood and/or tissue concentrations of other non-TDM drugs are measured by HPLC and are applied to treatment, which is necessary for personalized medicine. This review describes personalized medicine based on the use of chromatography as a result of the current situation in Japan.
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Affiliation(s)
- Fumiya Ebihara
- Department of Pharmacy, Tokyo Women’s Medical University Hospital, Tokyo 162-8666, Japan; (F.E.); (T.M.); (T.K.)
| | - Yukihiro Hamada
- Department of Pharmacy, Tokyo Women’s Medical University Hospital, Tokyo 162-8666, Japan; (F.E.); (T.M.); (T.K.)
- Correspondence:
| | - Hideo Kato
- Department of Pharmacy, Mie University Hospital, Mie 514-8507, Japan;
| | - Takumi Maruyama
- Department of Pharmacy, Tokyo Women’s Medical University Hospital, Tokyo 162-8666, Japan; (F.E.); (T.M.); (T.K.)
| | - Toshimi Kimura
- Department of Pharmacy, Tokyo Women’s Medical University Hospital, Tokyo 162-8666, Japan; (F.E.); (T.M.); (T.K.)
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