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[A case of metronidazole-induced encephalopathy that is difficult to differentiate from Wernicke encephalopathy]
Takayuki Konishi1, Junichi Uemura2, Shinji Yamashita2
1Department of Internal Medicine, Kawasaki Medical School, General Medical Center.
Abstract:
Herein, we present the case of a 76-year-old man diagnosed with an iliopsoas abscess 3 months prior and consequently administered metronidazole. The patient visited our facility complaining of difficulty in speaking and feeling unsteady when walking. Neurological findings showed dysarthria, nystagmus, and bilateral cerebellar ataxia. Head MRI-FLAIR demonstrated symmetrical hyperintensities in the bilateral cerebellar dentate nuclei, red nucleus, periaqueductal of the midbrain, periventricular third ventricle, and the corpus callosum. Although Wernicke's encephalopathy was among the differential diagnoses based on the imaging findings, the thiamine level was normal and improvement in symptoms and hyperintensity on FLAIR within 5 days of discontinuing metronidazole led to the diagnosis of metronidazole-induced encephalopathy. Although there were many similarities in the imaging findings of metronidazole-induced encephalopathy and Wernicke's encephalopathy, Metronidazole-induced encephalopathy should be initially considered when midbrain red nucleus lesions are observed.
Insights
A patient developed neurological symptoms including ataxia and dysarthria after metronidazole treatment for an iliopsoas abscess. The symptoms resolved after discontinuing the antibiotic, confirming metronidazole-induced encephalopathy.
Area of Science:
- Neurology
- Toxicology
Background:
- Metronidazole is an antibiotic commonly used to treat anaerobic bacterial infections.
- Neurological side effects, though rare, can occur with metronidazole use.
Observation:
- A 76-year-old male presented with dysarthria, nystagmus, and cerebellar ataxia following metronidazole treatment for an iliopsoas abscess.
- Head MRI revealed symmetrical hyperintensities in the cerebellum, midbrain, and corpus callosum.
Findings:
- The patient's symptoms and MRI findings mimicked Wernicke's encephalopathy.
- Normal thiamine levels and rapid symptom improvement after metronidazole cessation confirmed metronidazole-induced encephalopathy.
Implications:
- Metronidazole-induced encephalopathy should be considered in patients presenting with these neurological symptoms, especially when midbrain red nucleus lesions are present.
- Distinguishing metronidazole-induced encephalopathy from Wernicke's encephalopathy is crucial for appropriate management and treatment.
- This case highlights the importance of considering drug toxicity in the differential diagnosis of encephalopathy.
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