SHM Converge Scientific Abstract ePoster Gallery-Cefepime Induced Neutrapenic Fever, Rare Side Effect in a 25 Year Old: A Case Report.

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This case report describes a rare instance of cefepime-induced neutropenic fever in a 25-year-old man with no prior hematologic disease. The patient initially presented with seizures and headaches and was found to have a brain arteriovenous malformation. After surgical resection, he developed postoperative leukocytosis and fever. Lumbar puncture findings suggested bacterial meningitis, and wound cultures grew Klebsiella sensitive to cefepime. He was discharged on a planned 6-week course of outpatient IV cefepime.<br /><br />Three days later, he returned with high fever, chills, and night sweats despite taking the antibiotic as prescribed. On admission he was febrile, tachycardic, and hypotensive, and laboratory testing showed severe neutropenia with an absolute neutrophil count of 350 cells/mm³. After consultation with infectious disease and neurosurgery, cefepime was stopped and switched to meropenem. His symptoms improved within two days. Repeat lumbar puncture and MRI suggested postoperative changes rather than ongoing infection, and he was eventually discharged on outpatient IV ertapenem.<br /><br />The report emphasizes that although cefepime is commonly used and generally well tolerated, it can rarely cause neutropenia and neutropenic fever, likely through an idiosyncratic immune-mediated mechanism. Because this adverse effect is uncommon, it may be missed or mistaken for infection progression. The authors stress the importance of recognizing cefepime as a potential cause of unexplained fever and neutropenia, discontinuing the drug promptly, and starting an alternative antibiotic such as a carbapenem to prevent worsening complications.

Asset Subtitle

Jonathan D. Grube

Meta Tag

Author List Angelica Medina-Pena, Heena Patel, Jonathan D. Grube, Kathleen Mattingly, Mehak Sachdeva, Mitra Chandan

Category Clinical Vignettes

Concept Cefepime

Concept Neutropenia

Concept Neutropenic Fever

Concept Idiosyncratic Drug-Induced Neutropenia

Concept Cefepime Discontinuation

Distinguished Non-Finalist

Presenter Organization UCF/HCA Ocala Internal Medicine Residency

Presenting Author Jonathan D. Grube

Track Adult

Keywords

cefepime

neutropenic fever

neutropenia

case report

Klebsiella infection

bacterial meningitis

brain arteriovenous malformation

postoperative fever

meropenem

ertapenem

Cefepime

Neutropenia

Neutropenic Fever

Idiosyncratic Drug-Induced Neutropenia

Cefepime Discontinuation