Abstract
We describe a 47-year-old woman who presented with palinopsia and subacute altered mental change after cefditoren pivoxil administration. The patient showed characteristic clinical manifestations of hypocarnitinemia, which affected her state of consciousness and she had radiologic findings that revealed metabolic encephalopathy with cytotoxic edema in the right occipital area and intracranial hemorrhages in right occipital and left frontal areas. Follow-up imaging after oral carnitine supplementation demonstrated complete resolution of the bilateral frontal subcortical T2 high-intensity lesions. Carnitine deficiency due to cefditoren pivoxil treatment may present as metabolic encephalopathy in adults. This possibility should be considered with the differential diagnosis of encephalopathies, and carnitine levels should be checked in patients treated with cefditoren pivoxil.
Similar content being viewed by others
References
Holme E, Greter J, Jacobson CE, Lindstedt S, Nordin I, Kristiansson B, Jodal U (1989) Carnitine deficiency induced by pivampicillin and pivmecillinam therapy. Lancet 2(8661):469–473
Reuter SE, Evans AM, Chace DH, Fornasini G (2008) Determination of the reference range of endogenous plasma carnitines in healthy adults. Ann ClinBiochem. 45(Pt 6):585–592
Virmani A, Binienda Z (2004) Role of carnitine esters in brain neuropathology. Mol Aspects Med 25(5–6):533–549
Schäfer J, Reichmann H (1990) Subnormal carnitine levels and their correction in artificially fed patients from a neurological intensive care unit: a pilot study. J Neurol 237(3):213–215
Winter SC, Szabo-Aczel S, Curry CJ, Hutchinson HT, Hogue R, Shug A (1987) Plasma carnitine deficiency. Clinical observations in 51 pediatric patients. Am J Dis Child 141(6):660–665
Ito T, Sugiyama N, Kobayashi M et al (1995) Alteration of ammonia and carnitine levels in short-term treatment with pivalic acid containing prodrugs. Tohoku J Exp Med 175:43–53
Lheureux PE, Penaloza A, Zahir S, Gris M (2005) Science review: carnitine in the treatment of valproic acid-induced toxicity-what is the evidence? Crit Care 9(5):431–440
Averbuch-Heller L, Ben-Hur T, Reches A (1994) Valproate encephalopathy and hypocarnitinaemia in diabetic patients. J Neurol 241:567–569
Stanley CA (2004) Carnitine deficiency disorders in children. Ann N Y Acad Sci 1033:42–51
Todesco L, Bodmer M, Vonwil K, Häussinger D, Krähenbühl S (2009) Interaction between pivaloylcarnitine and l-carnitine transport into L6 cells over expressing hOCTN2. ChemBiol Interact 180(3):472–477
Bianchi MC, Sgandurra G, Tosetti M, Battini R, Cioni G (2007) Brain magnetic resonance in the diagnostic evaluation of mitochondrial. EncephalopathiesBiosci Rep 27:69–85
Acknowledgments
This study was supported by a grant of the Korean Health Technology R&D Project, Ministry of Health and Welfare, Republic of Korea (A101535).
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kim, H., Chu, K., Jung, KH. et al. Acquired encephalopathy associated with carnitine deficiency after cefditoren pivoxil administration. Neurol Sci 33, 1393–1396 (2012). https://doi.org/10.1007/s10072-012-0939-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10072-012-0939-7