QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Résumé Extracto Full Text PDF Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Articles Ahead of Print [Order Reprint] Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Barrett, M. J Articles by Login, I. S Search for Related Content PubMed PubMed Citation Articles by Barrett, M. J Articles by Login, I. S

Gemifloxacin-Associated Neurotoxicity Presenting as Encephalopathy

Senior Neurology Resident, Department of Neurology, University of Virginia Health System, Charlottesville, VA

Ivan S Login, MD

Professor of Neurology, Department of Neurology, University of Virginia Health System

Reprints: Dr. Login, Department of Neurology, University of Virginia Health System, PO Box 800394, Charlottesville, VA 22908, fax 434/982-1726, isl{at}hscmail.mcc.virginia.edu

OBJECTIVE: To report a case of acute encephalopathy associated with ingestion of gemifloxacin, a fluoroquinolone.

CASE SUMMARY: A 67-year-old woman presented to the emergency department with an acute alteration in mental status. Twenty-four hours earlier she had taken one 320-mg tablet of her husband's gemifloxacin prescription to treat symptoms of a mild upper respiratory infection. During her initial evaluation at our institution, the woman was dysphasic, unable to follow commands, and agitated, suggesting encephalopathy. A thorough diagnostic investigation did not reveal any structural, metabolic, or infectious etiology. Her mental status returned to normal within 2 days without any definitive treatment.

DISCUSSION: Fluoroquinolone-associated neurotoxicity may manifest as encephalopathy, seizures, confusion, or toxic psychosis. To date, none of these adverse effects, specifically encephalopathy, has been reported with gemifloxacin. An objective causality assessment revealed that encephalopathy was probably associated with gemifloxacin use. Seizures, either convulsive or nonconvulsive, may have contributed to our patient's presentation, but she denied seizures prior to this event and did not suffer a seizure in the 18 months following her discharge. However, her second electroencephalograph revealed an underlying predisposition to seizures, which gemifloxacin may have unmasked.

CONCLUSIONS: This report illustrates that severe central nervous system adverse effects associated with some fluoroquinolones may also occur with gemifloxacin. Gemifloxacin and other fluoroquinolones should be considered in the etiologic evaluation of patients with acute encephalopathy.

Key Words: encephalopathy, fluoroquinolone, gemifloxacin, seizure

Published Online, March 10, 2009. www.theannals.com, DOI 10.1345/aph.1L621