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Short-course metronidazole-induced reversible acute neurotoxicity in a renal transplant recipient

Pavitra Manu Dogra1, Anil Kumar Bhatt1, Sanjay Kumar Agarwal1

  • 1Department of Nephrology, All India Institute of Medical Sciences, New Delhi, India.

Saudi Journal of Kidney Diseases and Transplantation : an Official Publication of the Saudi Center for Organ Transplantation, Saudi Arabia
|December 28, 2018
PubMed

Insights

Acute neurotoxicity from short-term metronidazole use is rare, especially in renal transplant patients. This case highlights drug withdrawal as an effective treatment, independent of tacrolimus levels.

Area of Science:

  • Pharmacology
  • Nephrology
  • Neurology

Background:

  • Chronic metronidazole use is associated with neurotoxicity.
  • Short-term metronidazole-induced neurotoxicity is exceptionally rare.
  • Renal transplant recipients are a unique patient population with specific drug interaction concerns.

Observation:

  • A renal allograft recipient developed acute neurotoxicity after a short course of injectable metronidazole for persistent diarrhea.
  • The patient received standard doses of metronidazole.
  • Symptoms resolved upon discontinuation of metronidazole.

Findings:

  • Magnetic resonance imaging (MRI) of the brain revealed widespread osmotic demyelination.
  • Neurotoxicity resolved following drug withdrawal.
  • Tacrolimus trough concentrations remained stable, excluding a drug interaction as the cause.

Implications:

  • This case represents the first report of acute neurotoxicity from short-term metronidazole in a renal transplant recipient.
  • It underscores the potential for rare adverse drug reactions even with standard dosing.
  • The findings suggest metronidazole-induced neurotoxicity can occur independently of tacrolimus interactions in transplant patients.

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