A Case of Antibiotic-Induced Posterior Reversible Encephalopathy Syndrome

Abstract

Purpose: To report a case of posterior reversible encephalopathy syndrome (PRES) in a 75 year-old patient who was taking concomitant ciprofloxacin and metronidazole. Method: Case report Results: A patient had been prescribed ciprofloxacin and metronidazole during a recent hospitalization and continued this regimen outpatient. Two weeks after discharge and 3 weeks after initiation of her regimen, she was brought to the emergency department after developing acute weakness and lightheadedness. After admission, the patient declined more rapidly and began seizing with subsequent intubation. Initial computed tomographic (CT) imaging showed no acute neurological abnormalities, and a sepsis workup was initiated. After negative CT, a magnetic resonance imaging scan was performed that showed a T2 flair and hyperdensity consistent with PRES. The final diagnosis was considered to be PRES secondary to ciprofloxacin/metronidazole utilization. Conclusion: Antibiotic induced PRES is a condition that needs to be explored more thoroughly.

Posterior reversible encephalopathy syndrome associated with antibiotic therapy: a case report and systematic review

“…After duplicate removal, 187 articles were screened. Title and abstract screening led to the selection of 24 articles for full read, which brought us to a final number of 11 articles fulfilling the inclusion criteria and reporting one case each (Supplementary Table 1) [10][11][12][16][17][18][19][20][21][22][23]. Full data on literature case reports (n = 11) and on our case are summarized in Table 1 and detailed in Supplementary Table 1.…”

“…Based on clinical and radiological findings, the diagnosis of PRES was made [1]. Given the previous association between PRES and metronidazole administration reported in the literature [10][11][12], metronidazole was discontinued 3 days after first administration and replaced by vancomycin (125 mg × 4/die). Neurofilament light chain protein (NfL) was measured in serum using the ELLA technology as previously described [13].…”

“…No pathogen-specific patterns were found, but gastrointestinal infections were most common (4 of 12, 33.3%). Of note, three articles [10,11,18] described the possible association of 2 antibiotics each with PRES. Metronidazole and fluoroquinolones were the most commonly reported antibiotics, each being administered in 4 cases (33.3%) (Table 1).…”

Linezolid-Associated Posterior Reversible Leuco-encephalopathy Syndrome in a Patient with Disseminated Tuberculosis

“…Only a handful of antibiotics including ciprofloxacin, metronidazole, daptomycin, and amoxicillin + clavulanic acid has been reported to cause PRES. [6][7][8] Two other case reports of linezolid associated with PRES were reported in the literature. 9,10 Linezolid has an excellent blood brain barrier penetration, and it was added as modified ATT in our patient.…”