Approach to Cefepime-Induced Neurotoxicity in the Setting of Chronic Kidney Disease: A Case Report and Review of Literature.

Cefepime-induced neurotoxicity is well-known, but an under-recognized event that can present with a myriad of neurological findings ranging from myoclonus to seizures to comatose state. It is more prevalent in patients with impaired renal clearance as it is mainly cleared by the kidneys. We present a case of a 52-year-old female who was managed in the intensive care unit with severe encephalopathy following empiric antibiotic therapy with cefepime. Although we encountered some unforeseen difficulties executing our initial plan of renal replacement therapy, our patient was successfully treated with fluids and intravenous diuresis with furosemide and was ultimately discharged home with full recovery.

An Unusual Case of Non-traumatic Chylothorax.

Chylothorax refers to the presence of chyle in the paraaortic space. This entity most commonly occurs from injury to the thoracic duct, which carries chyle from the gastrointestinal tract to the bloodstream. Common etiologies around traumatic chylothorax include iatrogenic causes, such as surgical procedures near the thoracic duct and penetrating and blunt injuries to the chest. We present a case of a 49-year-old female who initially presented to the hospital with progressively worsening dyspnea leading to acute hypoxic respiratory failure requiring intubation and admission to the ICU. The patient's presentation was initially thought to be due to and managed as an infectious process with empyema and septic shock until a diagnosis of nontraumatic chylothorax was established. In this article, we report a complicated case of chylothorax, initially masquerading as an infectious pulmonary process. We hope to raise this entity high on the differential when clinicians are confronted with the task of managing patients with similar presentations, which will, in turn, prevent delayed diagnosis and the unnecessary use of antibiotics.

Amiodarone induced "Blue man syndrome"; an unusual presentation.

Amiodarone is a common antiarrhythmic medication used in daily practice with excellent efficiency. While it has many benefits, there are several common adverse reactions, such as abnormal thyroid function and cornea verticillata, associated with its use. A much less common adverse reaction is the so-called "Blue man syndrome," occurring in 1-3% of patients. Blue man syndrome is thought to stem from the deposition of lysosomal membrane-bound dense bodies, similar to lipofuscin, in the dermis of patients on chronic amiodarone therapy. We present the case of a 77-year-old male who presented to us post-cardiac arrest secondary to hyperkalemia of 7.0. Although it was noted in the patient's chart that he had an "allergy" to amiodarone (it was noted in his chart it only turned his leg black), it was used in the emergency department because of the failure of other antiarrhythmics to treat his arrhythmia and all other medical options were exhausted. It was decided that the benefits of using amiodarone far outweighed the risks of it. Ultimately it was found that the patient did not have a true allergy to amiodarone, but suffered from a known benign adverse effect of the drug resulting in a greyish-blue tinge to his bilateral lower extremities. His-presentation differs from the normal presentation of blue man syndrome which appears more commonly on sun-exposed areas of the body such as the face and arms. While this is a benign adverse effect of amiodarone, it can be very distressing to patients and must be addressed.