Reversible metronidazole-induced neurotoxicity after 10 weeks of therapy

Abstract

Metronidazole is a commonly used antimicrobial worldwide. The most common side effects that have been reported are nausea, vomiting and hypersensitivity reactions. However, neurotoxicity has been reported with the use of metronidazole but rather rare. The most common neurological manifestation is peripheral neuropathy involvement in the form of sensory loss. It is worth mentioning that central neurotoxicity is a rare side effect of metronidazole use but reversible. The manifestations vary from a headache, altered mental status to focal neurological deficits. The diagnosis is mainly by neuroimaging in the setting of acute neurological change in the patient status. Here, we report a case of metronidazole-induced neurotoxicity in a 38-year-old male patient who was admitted with a brain abscess and was started on metronidazole for more than 10 weeks.

Keywords: drugs and medicines; neurology (drugs and medicines); radiology (diagnostics).

Figure 1

The MRI image at initial presentation.

Figure 2

The MRI image after 8 weeks of treatment.

Figure 3

The MRI image on day 72 on diagnosing metronidazole-induced neurotoxicity.

Figure 4

Another MRI image showing metronidazole-induced neurotoxicity features.

Figure 5

The MRI image after cessation of metronidazole and resolution of changes.