Cefoxitin and ciprofloxacin neurotoxicity and catatonia in a patient on hemodialysis.

Catatonia is a neuropsychiatric psychomotor syndrome common to mood, psychotic, and developmental disorders, as well as many medical illnesses, including exposure to or withdrawal from a variety of pharmacologic agents. While the incidence of catatonia due to a general medical condition is difficult to characterize, in the consultation psychiatry setting the incidence of catatonia has been found to range from 1.6 to 3 percent. The pro-convulsive activity of cephalosporin and quinolone antibiotics has been well documented in the literature. This pro-convulsive effect has been attributed in animal models to their antagonism at the a-subtypes of -aminobutyric acid (GABA-A) receptors. Likewise, GABA-A hypoactivity has been theorized as a possible mechanism in catatonia. Case reports have associated catatonia with antibiotics (such as azithromycin, and various quinolones, including ciprofloxacin). However, the association of catatonia and cephalosporins has not been reported. This case describes a patient who developed catatonia and myoclonus after exposure to cefoxitin. After she was switched to ciprofloxacin, her catatonia worsened.