Management of levofloxacin induced anaphylaxis and acute delirium in a palliative care setting

Abstract

Levofloxacin is a commonly prescribed antibiotic for managing chest and urinary tract infections in a palliative care setting. Incidence of Levofloxacin-associated anaphylaxis is rare and delirium secondary to Levofloxacin is a seldom occurrence with only few published case reports. It is an extremely rare occurrence to see this phenomenon in combination. Early identification and prompt intervention reduces both mortality and morbidity. A 17-year-old male with synovial sarcoma of right thigh with chest wall and lung metastasis and with no prior psychiatric morbidity presented to palliative medicine outpatient department with community-acquired pneumonia. He was initiated on intravenous (IV) Ceftriaxone and IV Levofloxacin. Post IV Levofloxacin patient developed anaphylaxis and acute delirium necessitating IV Hydrocortisone, IV Chlorpheneramine, Oxygen and IV Haloperidol. Early detection and prompt intervention helped in complete recovery. Patient was discharged to hospice for respite after 2 days of hospitalization and then discharged home. Acute palliative care approach facilitated management of two life-threatening medical complications in a palliative care setting improving both quality and length of life.

Acute Delirium Associated With Levofloxacin

“…Drug-induced delirium is a well-known entity with sedatives, narcotics and anticholinergics most often implicated in its causation [ 3 , 5 ]. Delirium attributed to antibiotics, mainly cephalosporins and macrolids, has been infrequently reported [ 6 - 8 ], and until yet only seven cases of levofloxacin-induced delirium have been described in the medical literature [ 9 - 15 ], one of them from our medical ward [ 11 ].…”

“…Delirium attributed to antibiotics, mainly cephalosporins and macrolides, has been infrequently reported [ 6 - 8 ]. To the best of our knowledge, only seven cases of levofloxacin-induced delirium have been previously described in the medical literature [ 9 - 15 ], one of them from our medical ward [ 11 ]. We describe another case of delirium associated with levofloxacin in an elderly patient who was hospitalized in our medical ward for pneumonia.…”

Delirium Research in India: A Systematic Review

“…A total of 58 case reports/series have focused on delirium as the primary outcome/issue (►Table 8). Some of these case reports have reported association of delirium with medications such as levetiracetam, 92 levofloxacin, 93,94 fluoroquinolones, 95 zoledronate, 96 a combination of albendazole and ivermectin, 97 and use of cyclopentolate eye drops. 98 One report presented information about delirium associated with bath salts.…”

Levofloxacin-Associated Mania: A Case Report

“…There was abrupt onset of mania-like symptoms following treatment with levofloxacin that resolved rapidly after treatment with risperidone and lorazepam in our case, suggestive of possible diagnosis of levofloxacin-induced mania. Neuropsychiatric reactions have been reported with levofloxacin, most commonly delirium [10][11][12][13][14][15][16][17][18] and occasionally acute psychosis. [19][20][21] We did not find any report of mania associated with levofloxacin in PubMed using "levofloxacin" and "mania" as search terms.…”