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Metronidazole-Induced Encephalopathy (MIE).

Dinesh M Chaudhari¹, Pushpendra Nath Renjen², Urusa Hasan³

¹Internal Medicine/Neurosciences, Indraprastha Apollo Hospital, New Delhi, IND.

|February 1, 2023

Summary

Metronidazole, an essential antibiotic, can cause serious neurologic side effects like encephalopathy. This case highlights metronidazole-induced encephalopathy (MIE) in a patient with a liver abscess, presenting with gait and speech abnormalities.

Keywords:

altered sensorium dentate magnetic resonance imaging metronidazole toxicity

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Area of Science:

Neurology
Infectious Diseases
Pharmacology

Background:

Metronidazole is a crucial antibiotic for treating anaerobic, microaerophilic, and protozoal infections.
It is effective against various bacterial infections affecting multiple organ systems.
While generally safe, metronidazole can cause significant neurological adverse effects.

Observation:

A liver abscess patient developed altered sensorium, abnormal gait, and dysarthria after three weeks of metronidazole therapy.
Clinical presentation suggested a central nervous system complication.
Neurological examination revealed symptoms consistent with cerebellar and brainstem dysfunction.

Findings:

Brain MRI revealed bilateral symmetrical hyperintensities in the dentate nuclei and dorsal brainstem.
These findings were indicative of metronidazole-induced encephalopathy (MIE).
Absence of diffusion restriction on MRI supported MIE over other potential causes like stroke.

Implications:

This case underscores the importance of recognizing metronidazole-induced encephalopathy (MIE) as a potential complication.
Early diagnosis and discontinuation of metronidazole are crucial for managing MIE.
Awareness of MIE is vital for clinicians managing patients on long-term or high-dose metronidazole therapy.