Metronidazole-induced reversible cerebellar dysfunction

Abstract

A 73-year-old man who presented with fever and abdominal discomfort was diagnosed to have a liver abscess. He was treated with antimicrobials which included metronidazole. One month into treatment, he developed neurological symptoms and signs that were suggestive of cerebellar pathology. MRI of the brain showed T2/fluid attenuated inversion recovery hyperintensities involving bilateral dentate, fastigial and interpositus nuclei. After excluding common aetiologies, the possibility of metronidazole-induced neurotoxicity was considered. After stopping metronidazole, his symptoms and signs resolved. A subsequent MRI scan of the brain showed reversal of changes. Neurotoxicity caused by metronidazole is an uncommon adverse effect of a commonly used antimicrobial drug and should be considered in the appropriate clinical scenario.

Keywords: drugs: CNS (not psychiatric); neuroimaging; unwanted effects / adverse reactions.

Figure 1

(A) Ultrasound scan of the abdomen showing multiloculated heterogenous partially cystic lesion in the right lobe (segment VI/VII) of liver measuring 5.3×4.2×3.4 cm (~40.5 cc). (B) CT of the abdomen showing liver abscess with the same features.

Figure 2

MRI of the brain showing fluid attenuated inversion recovery hyperintensities involving bilateral dentate, fastigial and interpositus nuclei (A), corresponding areas appear hypointense on T1W imaging (B).