compromised renal functions and previous central nervous system ( cns ) disease have been shown to predispose to this neurotoxicity .
we describe a case of acute transient encephalopathy in a patient treated with ceftriaxonefor enteric fever infection .
the present case illustrates the diagnostic challenges and management of this rare but potentially severe side effect of one of the most commonly prescribed parenteral antibiotics .
an eight - year - old male child presented with a history of diarrhea and high - grade fever .
the child was conscious , cooperative , well oriented to time , place and persons .
the patient was hospitalized and started on ceftriaxone ( 1 g iv daily ) and intravenous fluids .
after three days of treatment with iv ceftriaxone , child became afebrile but showed altered mental status with progressive apathy and somnolence .
the patient was referred to the dyanand medical college , ludhiana ( punjab ) . in the emergency department ,
the patient was not in acute distress , had no fever , was hemodynamically stable , but dehydrated .
hb 12 g / dl [ normal range 12 to 15 g / dl ] , hct 38% [ normal range 35.0 to 49.0% ] , tlc 6 10/l l [ normal range 5 to 12 10/l l ] , dlc - n 62 [ normal range 6070% ] , l 27% [ normal range 2040% ] , plt 274 10/l l [ normal range 100 to 300 10/l ] , urea 14 mg / dl [ normal range 825 mg / dl ] , cr 0.6 mg / dl [ normal range 0.51.7 mg / dl ] , na / k 139/4 [ normal range 135147/ 3.55 meq / dl ] , urinalysis revealed no bacteriuria and pyuria , tsb / dsb 0.77/0 [ normal range 0.11.0/ < 0.2 mg / dl ] , sgot / pt 44/23 [ normal range 1147/ 753
iu / l ] , stoolr / e , 2d mri scan of brain did not reveal acute stroke .
the patient 's neurological status improved and three days later he was again alert and oriented .
the proposed mechanisms include a decrease in -amino butyric acid ( gaba)-mediated inhibition and cephalosporin - mediated release of cytokines .
in fact , cephalosporins may decrease gaba release from nerve terminals , increase excitatory amino acid release , and exert a competitive antagonism with gaba .
alternatively , cephalosporin treatment has been proposed to induce endotoxin release , which generates cytokines liberation , such as tumor necrosis factor- , a proinflammatory cytokine implicated in septic encephalopathy .
pre - existing cns abnormalities have been indicated as a risk factor for -lactams encephalopathy . in
this was not the case in our patient , who presented with enteric fever and dehydration corrected with intravenous fluids .
in fact , the temporal association of the encephalopathy induction and resolution with ceftriaxone administration and withdrawal makes this antibiotic highly likely to be responsible for the encephalopathy .
moreover , the temporal pattern is in accordance with previous publications reporting cephalosporin neurotoxicity , with a latency of one to ten days after drug initiation and regression of all neurological symptoms within two to seven days following ceftriaxone treatment suspension . we could establish a probable causal relationship between ceftriaxone and the encephalopathy ( naranjo score 6 ) .
the severity assessment revealed the adr to be moderate , suggesting that required therapeutic intervention and hospitalization prolonged by 1 day but resolved in 24 h or change in drug therapy or specific treatment to prevent a further outcome .
since this patient did not have a history of any such reaction due to ceftriaxone , this adverse drug reaction was unpreventable .
we describe a case of ceftriaxone - induced acute reversible encephalopathy in a patient treated for enteric fever infection .
early recognition of this complication is particularly relevant as discontinuation of ceftriaxone reverts the neurological syndrome .
 ceftriaxone is a commonly used , third - generation cephalosporin . 
 encephalopathy is a rare side effect of third- and fourth - generation cephalosporins . 
 renal failure and previous disease of the central nervous system predispose to this neurotoxicity . 
 we describe a case of acute transient encephalopathy in a patient treated with ceftriaxone for enteric fever infection . 
 early detection of this complication is relevant given that stopping the drug usually reverts the neurological syndrome . 
Introduction
Case Report
Discussion
Conclusion