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Hepatic Failure following Metronidazole in Children with Cockayne Syndrome

Pedram Ataee1, Avat Karimi2, Kambiz Eftekhari3

  • 1Liver and Digestive Research Center, Research Institute for Health Development, Department of Pediatric, Kurdistan University of Medical Sciences, Sanandaj, Iran.

Case Reports in Pediatrics
|February 22, 2020
PubMed

Insights

Cockayne syndrome patients face a high risk of fatal liver failure after metronidazole treatment. This case report highlights the critical need for awareness regarding metronidazole

Area of Science:

  • Pediatric Hepatology
  • Rare Genetic Disorders
  • Pharmacovigilance

Background:

  • Cockayne syndrome (CS) is a rare autosomal recessive disorder.
  • CS is characterized by microcephaly, growth abnormalities, and premature aging.
  • The safety of metronidazole in CS patients is not well-established.

Observation:

  • Two pediatric cases of Cockayne syndrome are presented.
  • Both patients received metronidazole for infections.
  • One patient died from acute liver failure; the other recovered with supportive care.

Findings:

  • Metronidazole administration was associated with severe hepatotoxicity in CS patients.
  • Acute liver failure occurred rapidly after metronidazole initiation in one case.
  • Clinical presentation included jaundice, vomiting, and altered mental status.

Implications:

  • Metronidazole poses a significant risk of fatal liver failure in children with Cockayne syndrome.
  • Healthcare providers must exercise extreme caution when considering metronidazole for CS patients.
  • Further research is needed to understand the pharmacogenetic basis of metronidazole toxicity in CS.

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