ABSTRACT
Despite popular use of piperacillin, the dire neurotoxicity associated with piperacillin
still goes unrecognized, leading to a delay in appropriate management. We report a
57-year-old woman with end-stage renal disease receiving continuous ambulatory peritoneal
dialysis (CAPD), who developed slurred speech, tremor, bizarre behavior, progressive
mental confusion, and 2 episodes of generalized tonic-clonic seizure (GTCS) after
5 doses of piperacillin/tazobactam (2 g/250 mg) were given for bronchiectasis with secondary infection. The laboratory data revealed
normal plasma electrolyte and ammonia levels but leukocytosis. Neurologic examinations
showed dysarthria and bilateral Babinski sign. Computed tomography of brain and electroencephalogram
were unremarkable. Despite the use of antiepileptic agents, another GTCS episode recurred
after the sixth dose of piperacillin/tazobactam. Brain magnetic resonance imaging
did not demonstrate acute infarction and organic brain lesions. Initiation of high-flux
hemodialysis rapidly reversed the neurologic symptoms within 4 hours. Piperacillin-induced encephalopathy should be considered in any uremic patients
with unexplained neurological manifestations. CAPD is inefficient in removing piperacillin,
whereas hemodialysis can rapidly terminate the piperacillin-induced encephalopathy.
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Article info
Publication history
Accepted:
September 6,
2006
Received:
July 25,
2006
Identification
Copyright
© 2007 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.
