Cefepime-induced encephalopathy following pancreaticoduodenectomy: a case report of a rare postoperative complication in gastrointestinal surgery.

We report a rare case of cefepime-induced encephalopathy (CE) after pancreaticoduodenectomy. An 83-year-old female patient underwent pancreaticoduodenectomy for a distal bile duct tumor. On postoperative day (POD) 6, she developed a pseudoaneurysm secondary to postoperative pancreatic fistula, for which interventional radiology (IVR) treatment was performed. A liver abscess developed after IVR treatment on POD 15. Multidrug-resistant P. aeruginosa was detected in a drain culture, prompting a change of antibiotic therapy to cefepime on POD 30. Antifungal therapy was initiated for fungemia; however, her renal function progressively deteriorated. On POD 56, the patient presented with vomiting, expressionlessness, and hypokinesia. However, brain computed tomography revealed no abnormalities. Involuntary movement of upper and lower limbs were noted on POD 64, but both magnetic resonance imaging and cerebrospinal fluid examination showed none remarkably abnormalities. On POD 66, epileptic waves were detected via an electroencephalogram (EEG). CE was suspected, and cefepime administration was discontinued on POD 69. The involuntary movements disappeared promptly after cefepime discontinuation (POD 70). By POD 80, her communication ability improved, and EEG findings normalized. The patient was discharged on POD 260. Clinicians should consider CE in any patient receiving cefepime who presents with altered mental status and neurological symptoms.