meropenem and Paraplegia

Encephalopathy is reported to have affected 250,000 people in the United States over the last decade, with considerable morbidity and mortality. Baclofen, a gamma-aminobutyric acid-B agonist that acts on the central nervous system, is the drug most widely used to treat spasticity. Baclofen overdose is a potentially deadly condition that can cause encephalopathy and can result from multiple etiologies. Renal disease can contribute to baclofen overdose and encephalopathy, and there are currently no dosing recommendations for patient's on baclofen with renal impairment.. We report an unusual case of a man aged 35 years who presented with persistent fevers, seizures, and normal mentation. The patient presented with intrathecal baclofen use and prior exposure to West Nile Virus. He developed acute kidney injury at hospital secondary to vancomycin use, and mental status declined.. This case highlights that patients with baclofen overdose can initially appear to have serious brain injury, however, full patient recovery can occur in <72 hours. This case provides additional insight into the guidelines for the treatment and management for unknown cause encephalopathy. This case also highlights the link between renal disease, baclofen, and encephalopathy through a review of the literature.

Topics: Acute Kidney Injury; Adult; Anti-Bacterial Agents; Baclofen; Brain Diseases; Electroencephalography; Fever; GABA-B Receptor Agonists; Humans; Infusion Pumps, Implantable; Infusions, Spinal; Male; Meropenem; Paraplegia; Seizures; Spasm; Spinal Cord Injuries; Vancomycin

Nocardia is a Gram-positive, partially acid-fast, catalase-positive, and urease-positive bacterium that grows aerobically. We present an extremely rare case of cauda equina syndrome due to isolated intramedullary Nocardia farcinica infection. A 44-year-old male presented with low backache and gradually progressive weakness in bilateral lower limbs followed by paraplegia. He was found to have a well-defined, sharply demarcated ring-enhancing lesion located from T11-T12 to L3 vertebral body. He underwent laminectomy and decompression. The histopathological examination revealed a Gram-positive filamentous organism that looks like Nocardia. The culture report was suggestive of Nocardia farcinica. He was then treated with antibiotics and had a remarkable clinical and radiological improvement.

Topics: Adult; Anti-Bacterial Agents; Cauda Equina; Cauda Equina Syndrome; Decompression, Surgical; Humans; Laminectomy; Low Back Pain; Magnetic Resonance Imaging; Male; Meropenem; Nocardia; Nocardia Infections; Paraplegia; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination