A case of antibiotic-associated epilepticus caused by cefepime during chemoradiotherapy in an oral cancer patient with renal impairment

Antimicrobial-associated epilepsy (A AE) is a drug-induced encephalopathy in which antimicrobial agents cause neurological symptoms such as impaired consciousness, aphasia, involuntary movements, and epileptic seizures.We report a case of AAE caused by cefepime (CFPM) in an oral cancer patient treated with chemoradiotherapy (CRT) .A 72-year-old man was referred to our department complaining of swelling and pain in his oral floor.We diagnosed the patient with oral floor squamous cell carcinoma (cT4aN2cM0) , and decided to perform CRT with carboplatin because of impaired renal function.During CRT, febrile neutropenia was observed and CFPM was administered.Four days after initiation of CFPM, the patient presented with impaired consciousness, aphasia, seizures, and an abnormal electroencephalogram. Finally, the patient was diagnosed with A AE, and the symptoms disappeared shortly after withdrawal of CFPM.A AE should be considered in patients who develop impaired consciousness while receiving antimicrobial therapy.In patients with impaired renal function, antimicrobial doses should be carefully determined to prevent the development of AAE.