Irreversible metronidazole encephalopathy in an elderly woman with primary biliary cholangitis

Area of Science:

• Neurology
• Toxicology
• Gastroenterology

Background:

• Primary biliary cholangitis (PBC) is a chronic liver disease.
• Metronidazole (MNZ) is an antibiotic commonly used for various infections.

Observation:

• An 82-year-old woman with PBC developed an irreversible neurological disorder.
• The condition was diagnosed as metronidazole-induced encephalopathy.

Findings:

• Metronidazole-induced encephalopathy, while typically reversible, can lead to severe, permanent neurological deficits in rare instances.
• This case highlights the potential for serious sequelae, including fatality, from MNZ-induced encephalopathy.

Implications:

• Judicious use of metronidazole is essential, particularly in elderly patients or those with compromised liver function.
• Long-term or high-dose metronidazole therapy requires careful monitoring to prevent neurotoxicity.
• This case underscores the importance of considering drug-induced neurological disorders in differential diagnoses, especially in vulnerable patient populations.