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Case Reports
. 2021 Mar 18;25(1):2016.
doi: 10.4102/sajr.v25i1.2016. eCollection 2021.

Metronidazole-induced encephalopathy

Vikash G Lala  1 , Bilal Bobat  2 , Mark Haagensen  3 , Prakash Kathan  4 , Adam Mahomed  1   2
Affiliations
Case Reports

Metronidazole-induced encephalopathy

Vikash G Lala et al. SA J Radiol. .

Abstract

Metronidazole is a widely used antibacterial and antiprotozoal agent for a number of conditions. Whilst its more common gastrointestinal side effects are well known, neurotoxicity remains under-recognised. Both central and peripheral neurological side effects have been described. This report describes a case of radiologically confirmed metronidazole-induced cerebellar ataxia in a cirrhotic patient with a review of the literature. Awareness of this side effect is essential for prompt recognition as early drug withdrawal leads to resolution in the majority of cases.

Keywords: corpus callosum lesions; dentate nucleus lesions; metronidazole; metronidazole adverse events; metronidazole-induced cerebellar ataxia; metronidazole-induced encephalopathy; metronidazole-induced neurotoxicity; splenium lesions.

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Conflict of interest statement

The authors declare that they have no financial or personal relationships that may have inappropriately influenced them in writing this article.

Figures

FIGURE 1
FIGURE 1
Fluid attenuated inversion recovery (a) and T2 turbospin echo sequence (b) demonstrating high signal intensity in the dentate nuclei bilaterally (white arrows).
FIGURE 2
FIGURE 2
Diffusion-weigthed imaging (a) indicating increased signal in the splenium of the corpus callosum and corresponding apparent diffusion coefficient map (b) showing a decreased signal in this area in keeping with restriction.
FIGURE 3
FIGURE 3
Fluid attenuated inversion recovery imaging at the 7-week follow-up imaging, demonstrating resolution of the previous dentate nuclei high signal; compare with Figure 1.
FIGURE 4
FIGURE 4
(a) Diffusion sequence showing resolution of the splenium lesion at follow up (b) Apparent diffusion coefficient map showing complete resolution of the splenium lesion at follow up imaging; compare with Figure 2.
See this image and copyright information in PMC

References

    1. Edlund C, Löfmark S, Nord CE. Metronidazole is still the drug of choice for treatment of anaerobic infections. Clin Infect Dis. 2010. February 1;50(Supplement_1):S16–S23. 10.1086/647939 - DOI - PubMed
    1. Morgan MH, Read AE, Speller DC. Treatment of hepatic encephalopathy with metronidazole. Gut. 1982. January;23(1):1–7. 10.1136/gut.23.1.1 - DOI - PMC - PubMed
    1. Maddrey WC. Role of antibiotics in the management of hepatic encephalophathy. Rev Gastroenterol Disord [serial online]. [cited 2020 Apr 09]. 2005;5(SUPPL. 1):S3–S9. Available from: http://www.scopus.com/inward/record.url?eid=2-s2.0-20544439543&partnerID... - PubMed
    1. Mekky MA, Riad AR, Gaber MA, et al. . Rifaximin versus metronidazole in management of acute episode of hepatic encephalopathy: An open labeled randomized clinical trial. Arab J Gastroenterol. 2018;19(2):76–79. 10.1016/j.ajg.2018.06.001 - DOI - PubMed
    1. McDonald LC, Gerding DN, Johnson S, et al. . Clinical practice guidelines for Clostridium difficile infection in adults and children: 2017 update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA). Clin Infect Dis. 2018;66(7):e1–e48. 10.1093/cid/cix1085 - DOI - PMC - PubMed

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