Ertapenem-Induced Encephalopathy: A Case Report Highlighting Carbapenem-associated Neurotoxicity

Abstract

Background: Ertapenem is a once-daily carbapenem antibiotic commonly used in the treatment of complicated infections. Although traditionally associated with a lower risk of central nervous system (CNS) toxicity compared to imipenem, emerging reports highlight the potential for ertapenem-induced neurotoxicity, especially in patients with renal impairment and hypoalbuminemia. Early recognition is crucial, as symptoms are often reversible with drug discontinuation Case Presentations: We report a case of a 46-year-old woman with type 2 diabetes, advanced chronic kidney disease, developmental delay, and hypoalbuminemia who developed acute encephalopathy with visual hallucinations approximately three weeks into outpatient ertapenem therapy for suspected diabetic foot osteomyelitis. Despite stable vitals and supportive care for acute kidney injury, she exhibited a sudden decline in mental status. Extensive investigations excluded metabolic, structural, and infectious causes. Ertapenem was discontinued, and the patient was treated with intravenous albumin and supportive measures, resulting in rapid and complete neurologic recovery within 48 hours. A Naranjo score of 7 supported a probable adverse drug reaction. Conclusions: This case highlights ertapenem-induced encephalopathy as a reversible yet under recognized complication in vulnerable populations. Risk factors such as renal dysfunction and hypoalbuminemia should prompt close monitoring and dose adjustment. Albumin infusion may represent a promising adjunctive therapy in select cases.