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]