Key Clinical Message
Negative myoclonus may present in the early stages of cefepime neurotoxicity. Cefepime neurotoxicity typically presents as reduced consciousness, myoclonus, and seizures; however, negative myoclonus is uncommon. This video shows an older woman with cefepime neurotoxicity that presented as a negative myoclonus of the upper limbs.
Keywords: asterixis, cefepime, negative myoclonus, neurotoxicity
1. CASE VIDEOS
An 82‐year‐old woman with vertebral osteomyelitis caused by Klebsiella aerogenes was restless after 14 days of treatment with cefepime (2 g every 12 h). She had no history of liver disease or neuromuscular disorder. Physical examination revealed a negative myoclonus of the upper limbs (Video S1). No hyperammonemia, azotemia, hypoglycemia, hypercapnia, abnormal liver function tests, or electrolyte abnormalities were observed. Cefepime was discontinued and levofloxacin was initiated, resulting in the resolution of symptoms within 2 days (Video S2), suggesting cefepime neurotoxicity. Cefepime neurotoxicity typically presents as reduced consciousness, myoclonus, and seizures. 1 , 2 Negative myoclonus is a rare presentation of cefepime neurotoxicity; however, this case demonstrates that it can manifest during the early stages of cefepime neurotoxicity.
AUTHOR CONTRIBUTIONS
Daichi Umemoto: Writing – original draft; writing – review and editing. Hirokazu Kuroda: Supervision; validation; writing – original draft; writing – review and editing. Hiroaki Nishioka: Supervision; validation; writing – review and editing.
FUNDING INFORMATION
This study did not receive any specific grants from funding agencies in the public, commercial, or not‐for‐profit sectors.
CONFLICT OF INTEREST STATEMENT
None.
ETHICS STATEMENT
Our institutional review board did not require further approval for this report.
CONSENT
Written informed consent was obtained from the patient to publish this report in accordance with the journal's patient consent policy.
Supporting information
Video S1.
Video S2.
Umemoto D, Kuroda H, Nishioka H. Negative myoclonus as a manifestation of cefepime neurotoxicity. Clin Case Rep. 2024;12:e8380. doi: 10.1002/ccr3.8380
DATA AVAILABILITY STATEMENT
Data sharing is not applicable to this article, as no datasets were generated or analyzed in the current study.
REFERENCES
- 1. Boschung‐Pasquier L, Atkinson A, Kastner LK, et al. Cefepime neurotoxicity: thresholds and risk factors. A retrospective cohort study. Clin Microbiol Infect. 2020;26(3):333‐339. doi: 10.1016/j.cmi.2019.06.028 [DOI] [PubMed] [Google Scholar]
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
Video S1.
Video S2.
Data Availability Statement
Data sharing is not applicable to this article, as no datasets were generated or analyzed in the current study.