title: Piperacillin/tazobactam-induced neurotoxicity in a hemodialysis patient: a case report.
abstract: Antibiotics are potentially a cause of neurotoxicity in dialysis patients, the most common are the beta-lactams as ceftazidime and cefepime, and few cases have been reported after piperacillin/tazobactam use. This report presents a case of a hypertensive and diabetic 67-year-old woman in regular hemodialysis, which previously had a stroke. She was hospitalized presenting pneumonia, which was initially treated with cefepime. Two days after treatment, she presented dysarthria, left hemiparesis, ataxia, and IX and X cranial nerves paresis. Computed tomography showed no acute lesions and cefepime neurotoxicity was hypothesized, and the antibiotic was replaced by piperacillin/tazobactam. The neurologic signs disappeared; however, 4 days after with piperacillin/tazobactam treatment, the neurological manifestations returned. A new computed tomography showed no new lesions, and the second antibiotic regimen withdrawn. After two hemodialysis sessions, the patient completely recovered from neurological manifestations. The patient presented sequentially neurotoxicity caused by two beta-lactams antibiotics. This report meant to alert clinicians that these antibiotics have dangerous neurological effects in chronic kidney disease patients.
authors.affiliation: Internal Medicine Department, University of São Paulo State, São Paulo, Brazil.
authors.forename: Precil Diego M M
authors.initials: PD
authors.lastname: Neves
authors.forename: Fernanda M
authors.initials: FM
authors.lastname: Freitas
authors.forename: Christiane A
authors.initials: CA
authors.lastname: Kojima
authors.forename: Beatriz L
authors.initials: BL
authors.lastname: Carmello
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Bazan
authors.forename: Pasqual
authors.initials: P
authors.lastname: Barretti
authors.forename: Luis C
authors.initials: LC
authors.lastname: Martin
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D020258:Neurotoxicity Syndromes / Q000209:etiology*; D010397:Penicillanic Acid / Q000009:adverse effects / Q000031:analogs & derivatives*; D010878:Piperacillin / Q000009:adverse effects; D000077725:Piperacillin, Tazobactam Drug Combination; D006435:Renal Dialysis / Q000009:adverse effects*; D051436:Renal Insufficiency, Chronic / Q000150:complications*
chemical_list: D000077725:Piperacillin, Tazobactam Drug Combination; D010397:Penicillanic Acid; D010878:Piperacillin
keywords: Chronic kidney disease; hemodialysis; neurotoxicity; piperacillin/tazobactam