title: Penicillin Encephalopathy: An Unlikely Adversary in the Treatment of Neurosyphilis--Case Report and Review of the Literature.
abstract: Penicillin encephalopathy is a rare, potentially reversible phenomenon of drug-induced neurotoxicity.
  
  
  METHODS
  A 65-year-old female with a history of HIV was admitted with a three-day history of worsening headache, confusion, and lethargy. On examination she was awake but confused. Cerebrospinal fluid (CSF) and serum venereal disease research laboratory (VDRL) test returned positive and the patient was started on intravenous penicillin G with probenecid. On the second day of therapy, she developed myoclonic jerking, consistent with penicillin neurotoxicity. Repeat labs also showed new onset renal failure. Penicillin and probenecid therapy were stopped with a resolution of symptoms. Subsequently, therapy without probenecid was reinstituted uneventfully.
  
  
  CONCLUSIONS
  Herein, we describe a female who developed penicillin neurotoxicity after initiation of intravenous penicillin therapy with probenecid for neurosyphilis. It is important that penicillin-induced toxicity be considered if characteristic myoclonic movements accompany encephalopathy. The presence of coexistent renal compromise should heighten the vigilance of clinicians.
authors.forename: Vincent
authors.initials: V
authors.lastname: Covelli
authors.forename: Dipen B
authors.initials: DB
authors.lastname: Khanapara
authors.forename: Edgar R
authors.initials: ER
authors.lastname: Naut
mesh_terms: D000277:Adjuvants, Pharmaceutic / Q000008:administration & dosage / Q000009:adverse effects; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects; D001927:Brain Diseases / Q000139:chemically induced* / Q000517:prevention & control; D005260:Female; D015658:HIV Infections / Q000150:complications; D006801:Humans; D009494:Neurosyphilis / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology; D010400:Penicillin G / Q000008:administration & dosage / Q000009:adverse effects; D011339:Probenecid / Q000008:administration & dosage / Q000009:adverse effects; D051437:Renal Insufficiency / Q000139:chemically induced; D013588:Syphilis Serodiagnosis / Q000379:methods; D016896:Treatment Outcome
chemical_list: D000277:Adjuvants, Pharmaceutic; D000900:Anti-Bacterial Agents; D011339:Probenecid; D010400:Penicillin G