A case report of metronidazole-induced encephalopathy in Bangladesh

Authors

  • Shahriar Mahmud Department of Internal Medicine, Sher-E-Bangla Medical College and Hospital, Barisal, Bangladesh

DOI:

https://doi.org/10.18203/2349-3933.ijam20231455

Keywords:

Metronidazole, Encephalopathy, Dentate nucleus hyperintensity, Neurotoxicity

Abstract

Metronidazole-induced encephalopathy (MIE) is a rare disorder that can be reversible but fatal if not recognized early. Here, the author presents a case of encephalopathy in a 36-year-old patient who took 500 mg of metronidazole three times daily for three weeks. The patient was classified as a probable MIE case on the Naranjo causality assessment scale. An interesting neuroimaging finding in this patient was an isolated dentate nucleus signal abnormality. Author aims to report reversible clinical and radiological features of MIE in this patient and compare them with documented cases in recent and old literature. Data from this case report may guide clinicians to make judicious considerations in the early detection of MIE and may influence future researchers to focus on identifying critical mechanisms of devastating adverse effects, predictability of neurotoxicity.

References

Roy U. Clinical and Neuroradiological Spectrum of Metronidazole Induced Encephalopathy: Our Experience and the Review of Literature. JCDR. 2016;1.

Löfmark S, Edlund C, Nord CE. Metronidazole Is Still the Drug of Choice for Treatment of Anaerobic Infections. Clin Infect Dis. 2010;50:S16-23.

Ahmed SM, Hossain MdA. Knowledge and practice of unqualified and semi-qualified allopathic providers in rural Bangladesh: Implications for the HRH problem. Health Policy. 2007;84:332-43.

Biswas M, Roy MN, Manik MIN, Hossain MS, Tapu STA, Moniruzzaman M et al. Self-medicated antibiotics in Bangladesh: a cross-sectional health survey conducted in the Rajshahi City. BMC Public Health. 2014;14:847.

Chereau F, Opatowski L, Tourdjman M, Vong S. Risk assessment for antibiotic resistance in South East Asia. BMJ. 2017;j3393.

Hernández CA, Romero-Quezada LC, Ruvalcaba Ledezma JC, López CL. Therapeutic uses of metronidazole and its side effects: an update. Eur Rev Med Pharmacological Sci. 2019;23:397-401.

Tang P, Croxen MA, Hasan MR, Hsiao WWL, Hoang LM. Infection control in the new age of genomic epidemiology. Am J Infection Control. 2017;45:170-9.

Samuelson J. Why Metronidazole Is Active against both Bacteria and Parasites. Anti-microb Agents Chemother. 1999;43:1533-41.

Ahmed A, Loes DJ, Bressler EL. Reversible Magnetic Resonance Imaging Findings in metronidazole-induced Encephalopathy. Neurology. 1995;45:588-9.

Ralph ED. Clinical Pharmacokinetics of Metronidazole: Clinical Pharmacokinetics. 1983;8:43-62.

Zaki S. Adverse drug reaction and causality assessment scales. Lung India. 2011;28:152.

Mekky MA, Riad AR, Gaber MA, Abdel-Malek MO, Swifee YM. Rifaximin versus metronidazole in management of acute episode of hepatic encephalopathy: An open labelled randomized clinical trial. Arab J Gastroenterol. 2018;19:76-9.

Chaturvedi S, Malik MY, Rashid M, Singh S, Tiwari V, Gupta P et al. Mechanistic exploration of quercetin against metronidazole induced neurotoxicity in rats: Possible role of nitric oxide isoforms and inflammatory cytokines. Neuro Toxicol. 2020;79:1-10.

Bradley WG, Karlsson IJ, Rassol CG. Metronidazole neuropathy. BMJ. 1977;2:610-1.

Sørensen CG, Karlsson WK, Amin FM, Lindelof M. Metronidazole-induced encephalopathy: a systematic review. J Neurol. 2020;267:1-13.

Cantador AA, Meschia JF, Freeman WD, Tatum WO. Nonconvulsive Status with Metronidazole. The Neurohospitalist. 2013;3:185-9.

Bond KM, Brinjikji W, Eckel LJ, Kallmes DF, McDonald RJ, Carr CM. Dentate Update: Imaging Features of Entities That Affect the Dentate Nucleus. Am J Neuroradiol. 2017;38:1467-74.

Downloads

Published

2023-05-25

Issue

Section

Case Reports