J Med Cases

Journal of Medical Cases, ISSN 1923-4155 print, 1923-4163 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Med Cases and Elmer Press Inc

Journal website https://jmc.elmerpub.com

Case Report

Volume 16, Number 1, January 2025, pages 11-16

Ciprofloxacin-Induced Encephalopathy

↓ Figure 1. Axial section of a brain magnetic resonance imaging showing mild cortical atrophy (white arrows) and chronic white matter changes (red arrows), without acute pathology.

↓ Figure 2. Graphical representation of the patient’s clinical course demonstrating onset of symptoms and time to recovery. Time is displayed with 0 indicating date of hospital admission and cessation of ciprofloxacin (T = 0). Each day prior is notated by a negative sign and each day after is notated by a positive sign (e.g. T = -5 indicates five days prior to hospital admission).

↓ **Table 1.** Initial Laboratory Findings Showing a Normal Complete Blood Count, Basic Metabolic Panel, Syphilis Screen, Human Immunodeficiency Virus Screen, Vitamin B12 Level, and Hepatitis Panel
Laboratory test	Reference values	Measured values
BUN: blood urea nitrogen; HIV: human immunodeficiency virus; TSH: thyroid-stimulating hormone.
White blood cells (cells/µL)	4,300 - 11,100	4,400
Hemoglobin (g/dL)	11.5 - 15.5	14.1
Hematocrit (%)	36 - 46	42
Platelet (cells/µL)	120,000 - 360,000	190,000
Neutrophils (%)	38 - 75	70
Lymphocytes (%)	20 - 48	16
Sodium (mEq/L)	135 - 148	142
Potassium (mEq/L)	3.5 - 5.5	3.9
Chloride (mEq/L)	98 - 110	105
Bicarbonate (mmol/L)	24 - 34	26
BUN (mg/dL)	8 - 20	12
Creatinine (mg/dL)	0.5 - 1.5	1.23
Glucose (mg/dL)	70 - 140	136
Calcium (mg/dL)	8.5 - 10.5	9.1
Phosphorous (mg/dL)	2.4 - 4.4	3.1
Magnesium (mg/dL)	1.6 - 2.3	1.9
Ammonia (µg/dL)	20 - 80	19
TSH (mIU/L)	0.35 - 5.5	1.2
Vitamin B12 (pg/mL)	250 - 1,100	485.8
Syphilis IgG/IgM	Non-reactive	Non-reactive
HIV-1/HIV-2 antibody	Non-reactive	Non-reactive
Hepatitis A IgM	Non-reactive	Non-reactive
Hepatitis B surface antigen	Non-reactive	Non-reactive
Hepatitis C antibody IgG	Non-reactive	Non-reactive

↓ Table 1. Initial Laboratory Findings Showing a Normal Complete Blood Count, Basic Metabolic Panel, Syphilis Screen, Human Immunodeficiency Virus Screen, Vitamin B12 Level, and Hepatitis Panel

Laboratory test

Reference values

Measured values

BUN: blood urea nitrogen; HIV: human immunodeficiency virus; TSH: thyroid-stimulating hormone.

White blood cells (cells/µL)

4,300 - 11,100

4,400

Hemoglobin (g/dL)

11.5 - 15.5

14.1

Hematocrit (%)

36 - 46

Platelet (cells/µL)

120,000 - 360,000

190,000

Neutrophils (%)

38 - 75

Lymphocytes (%)

20 - 48

Sodium (mEq/L)

135 - 148

142

Potassium (mEq/L)

3.5 - 5.5

3.9

Chloride (mEq/L)

98 - 110

105

Bicarbonate (mmol/L)

24 - 34

BUN (mg/dL)

8 - 20

Creatinine (mg/dL)

0.5 - 1.5

1.23

Glucose (mg/dL)

70 - 140

136

Calcium (mg/dL)

8.5 - 10.5

9.1

Phosphorous (mg/dL)

2.4 - 4.4

3.1

Magnesium (mg/dL)

1.6 - 2.3

1.9

Ammonia (µg/dL)

20 - 80

TSH (mIU/L)

0.35 - 5.5

1.2

Vitamin B12 (pg/mL)

250 - 1,100

485.8

Syphilis IgG/IgM

Non-reactive

HIV-1/HIV-2 antibody

Non-reactive

Hepatitis A IgM

Non-reactive

Hepatitis B surface antigen

Non-reactive

Hepatitis C antibody IgG

Non-reactive

↓ **Table 2.** Urinalysis on Hospital Day 2 Without Evidence of Infection
Laboratory Test	Reference values	Measured values
Urine color	Yellow, dark yellow, green, straw	Yellow
Urine clarity	Clear	Clear
pH	5 - 8	7
Leukocyte esterase	Negative	Negative
Nitrite	Negative	Negative
Protein	Negative	1+
Glucose	Negative	Negative
Bilirubin	Negative	Negative
Ketones	Negative	Trace
Blood	Negative	1+
Specific gravity	1.003 - 1.035	1.008
White blood cells	0 - 5/hpf	0 - 5
Red blood cells	0 - 4/hpf	4 - 8
Bacteria	Negative/hpf	Negative
Squamous epithelial cells	None/hpf	None

↓ Table 2. Urinalysis on Hospital Day 2 Without Evidence of Infection

Laboratory Test

Reference values

Measured values

Urine color

Yellow, dark yellow, green, straw

Yellow

Urine clarity

Clear

5 - 8

Leukocyte esterase

Negative

Nitrite

Negative

Protein

Negative

Glucose

Negative

Bilirubin

Negative

Ketones

Negative

Trace

Blood

Negative

Specific gravity

1.003 - 1.035

1.008

White blood cells

0 - 5/hpf

0 - 5

Red blood cells

0 - 4/hpf

4 - 8

Bacteria

Negative/hpf

Negative

Squamous epithelial cells

None/hpf

None

↓ **Table 3.** Summary of Cases of Fluoroquinolone-Related Encephalopathy
Medication	Age	Sex	Symptoms	Reference
Levofloxacin	42	F	Psychosis and delirium	[8]
Levofloxacin	73	M	Confusion and hyperactive delirium	[9]
Levofloxacin	51	M	Encephalopathy and myclonus	[10]
Ciprofloxacin	16	M	Posterior reversible encephalopathy	[12]

↓ Table 3. Summary of Cases of Fluoroquinolone-Related Encephalopathy

Medication

Age

Sex

Symptoms

Reference

Levofloxacin

Psychosis and delirium

[8]

Levofloxacin

Confusion and hyperactive delirium

[9]

Levofloxacin

Encephalopathy and myclonus

[10]

Ciprofloxacin

Posterior reversible encephalopathy

[12]