Long-term Postthoracotomy Pain

metabolic factors,― including hypoxemiaand a high normal theophylline level, had caused the seizure. One year later a bronchopleural fistula developed at the bronchial stump ofa prior upper lobectomy (performed for control of cavitary MA! infection ten years previously). Hospitalization ensued, and the patient was treated for lower lobe pneumonia with cefuroxime. An infectious disease consultation suggested that he be discharged on a regimen of ciprofloxacin, 500 mg twice daily, to treat both active MAI and community-acquired pathogens. One week after discharge the patient presented to the emergency room in status epilepticus. Administration of diazepam to control seizures caused a respiratory arrest, and intubation and mechanical ventilation were unsuccessful due to rupture of the bronchopleural fistula. The serum theophylline level was 10.8 @Wml,and the serum sodium concentration was 131 @g/ml. No other cause of seizure could be located, although the head CT scan was not completed due to his cardiac arrest in the CT room. The Physicians' Desk Reference' lists seizures as a possible adverse reaction associated with ciprofloxacin, but it should be emphasized that they can occur in the presence ofa normal serum theophylline level. A recent literature review revealed only one case of seizures associated with a quinolone antibiotic.2 With the increasing use of this class of antibiotics,@ I believe it is critically important that physicians he aware of the potential for seizure activity in the absence ofan elevated serum theophylline level.