Rare case of metronidazole-induced encephalopathy in a multiple transplant recipient: Clinical and radiological insights

Abstract

Metronidazole-induced encephalopathy (MIE) is a rare but reversible condition that can present with nonspecific neurological symptoms, making early recognition and diagnosis challenging. Magnetic resonance imaging (MRI) is crucial in identifying typical brain lesions associated with MIE. Prompt discontinuation of metronidazole typically results in symptom resolution and improvement in MRI findings.

Keywords: encephalopathy; metronidazole; metronidazole‐induced encephalopathy; neuropathy; side effect.

FIGURE 1

MRI head with intravenous contrast was done which demonstrated multifocal areas of T2/FLAIR hyperintensities and diffusion restriction in the splenium of the corpus callosum, bilateral posterior pontomedullary junction, bilateral inferior colliculi, and bilateral dentate nuclei. Findings are classic for metronidazole‐induced encephalopathy. MRI head with IV contrast (A–C) T2, (D–F) FLAIR, (G–I) DWI and (J–L) ADC images showing T2/FLAIR hyperintensities and diffusion restriction in the splenium of corpus callosum (Yellow arrows), bilateral posterior pontomedullary junction (Green arrows), bilateral inferior colliculi (Blue arrows) and bilateral dentate nuclei (Red arrows).

FIGURE 2

Repeated MRI head with IV contrast showed complete resolution of the previously noted T2/FLAIR hyperintensities and diffusion restriction in the splenium of the corpus callosum, bilateral posterior pontomedullary junction, bilateral inferior colliculi, and bilateral dentate nuclei. MRI head with IV contrast (A–C) T2, (D–F) FLAIR, (G–I) DWI and (J–L) ADC images showing total resolution of the previously noted T2/FLAIR hyperintensities and diffusion restriction in the splenium of corpus callosum (Yellow arrows), bilateral posterior pontomedullary junction (Green arrows), bilateral inferior colliculi (Blue arrows) and bilateral dentate nuclei (Red arrows).