Metronidazole-induced encephalopathy in a patient with infectious colitis: a case report

Abstract

IntroductionEncephalopathy is a rare disease caused by adverse effects of antibiotic drugs such as metronidazole. The incidence of metronidazole-induced encephalopathy is unknown, although several previous studies have addressed metronidazole neurotoxicity. Here, we report the case of a patient with reversible cerebellar dysfunction on magnetic resonance imaging, induced by prolonged administration of metronidazole for the treatment of infectious colitis.Case presentationA 71-year-old Asian man, admitted to our hospital with hematochezia, underwent Hartmann's operation for the treatment of colorectal cancer three years ago. He was diagnosed with an infectious colitis by colonoscopy. After taking metronidazole, he showed drowsiness and slow response to verbal commands. Brain magnetic resonance imaging showed obvious bilateral symmetric hyperintensities within his dentate nucleus, tectal region of the cerebellum, and splenium of corpus callosum in T2-weighted images and fluid attenuated inversion recovery images. Our patient's clinical presentation and magnetic resonance images were thought to be most consistent with metronidazole toxicity. Therefore, we discontinued metronidazole, and his cerebellar syndrome resolved. Follow-up magnetic resonance imaging examinations showed complete resolution of previously noted signal changes.ConclusionMetronidazole may produce neurologic side effects such as cerebellar syndrome, and encephalopathy in rare cases. We show that metronidazole-induced encephalopathy can be reversed after cessation of the drug. Consequently, careful consideration should be given to patients presenting with complaints of neurologic disorder after the initiation of metronidazole therapy.

Metronidazole-Induced Encephalopathy Diagnosed by Follow-Up Brain Magnetic Resonance Imaging

“…In each of the cases we reviewed, including ours, there was symmetrical increase of T2 signal intensity and absence of mass effect and enhancement. Reversible changes have previously been observed through MRI in the brains of patients with MIE [9].…”

Efficacy of metronidazole versus placebo in pain control after hemorrhoidectomy. Results of a controlled clinical trial

“…Metronidazole is used in clinical practice and surgery, and is also used with good results to treat Crohn's disease (23) and for Helicobacter pylori infection eradication (24) and colonic preparation before colorectal surgery (25). Metronidazole is used widely because of its efficacy, safety, low cost, and low rate of adverse events (21,26). In the proctology field, it is used in combination with other antibiotics against infections by anaerobic bacteria, according to the extent and severity of the injury.…”

Metronidazole induced cerebellar ataxia

“…Gadolinium contrast did not show any enhancement in these lesions and the lesions resolved several weeks after discontinuing metronidazole. [67]…”