Bismuth toxicity: a rare cause of non-convulsive status epilepticus

Introduction Bismuth is a heavy metal that is used for therapeutic purposes including over the counter formulations. Here we describe a case of status epilepticus related to bismuth toxicity.Case report A 77-year-old woman had witnessed seizures at home which continued as status epilepticus in the hospital. Neuroimaging did not reveal a cause of seizures, which continued despite correction of various metabolic derangements. Lumbar puncture later did not reveal signs of infection. She eventually required numerous antiepileptic agents to maintain burst suppression. Bismuth concentrations were elevated in the urine (5800 mcg/L) and cerebrospinal fluid (1.8 mcg/L).Discussion Status epilepticus is a neurologic emergency that requires hospitalization with a variety of potential causes including bismuth intoxication. Recent initiation of bismuth subsalicylate and high concentrations in the urine and cerebrospinal fluid support bismuth toxicity as the cause of refractory status epilepticus in this patient.