Disclosures: Donovan Wilcox: No financial relationships or conflicts of interest

Case Diagnosis: This is a non-traumatic spinal cord injury with incomplete tetraplegia and acute functional decline secondary to Cefepime toxicity.

Case Description or Program Description: We describe a 59-year-old female who initially presented with incomplete quadriparesis secondary to methicillin-susceptible Staphylococcus aureus (MSSA) bacteremia with epidural abscesses and osteomyelitis. She underwent anterior cervical discectomy and fusion of C4-C7, decompressive thoracic laminectomy of T4-T5 and T12-L5, and began intravenous Cefazolin. On arrival to an inpatient rehabilitation facility, she was alert and oriented x 4 with generalized weakness, diffuse sensory changes, 2+ reflexes in upper and lower extremities and negative Babinski and Hoffman’s. Due to pseudomonas growth on upper thoracic wound, Cefazolin was discontinued and was switched to Cefepime 2g every 8 hours. 10 days after starting Cefepime, she developed encephalopathy, aphasia, and myoclonus in bilateral wrists.

Setting: Inpatient rehabilitation

Assessment/Results: Cefepime was discontinued, and the patient had acute and dramatic improvement, returning to baseline within 3 days. It was discovered that the patient had lost significant weight relative to her admission, resulting in miscalculated dosing and toxicity of Cefepime.

Discussion (relevance): Cefepime neurotoxicity occurs due to its ability to cross the blood brain barrier and antagonize ϒ-aminobutyric acid receptors. It is most common in patients with decreased renal function and older age, and common symptoms include altered mental status, myoclonus, and non-convulsive status epilepticus. Medication toxicity is important to understand and keep on our differential; in this case her acute presentation produced a significant barrier to rehabilitation.

Conclusions: Antibiotics, particularly cefepime, can lead to neurotoxicity causing acute decline of functional status in rehabilitation patients. It is crucial to remain aware of this and other less common causes of decline, particularly with distracting injuries and disease. Additionally, this case serves as a reminder that charted body weight may not inaccurate, potentially leading to incorrect dosing and thus adverse effects.

Level of Evidence: Level IV

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/functional-decline-in-an-incomplete-tetraplegic-due-to-cefepime-toxicity-a-case-report/