Metronidazole-induced toxicity of the central and peripheral nervous system

Area of Science:

• Neurology
• Pharmacology
• Toxicology

Background:

• Drug-induced neurological complications are increasingly recognized, particularly in aging populations using multiple medications.
• Metronidazole is an antibiotic commonly used for various infections.

Purpose of the Study:

• To highlight metronidazole neurotoxicity as a rare but significant adverse effect.
• To emphasize the importance of considering metronidazole neurotoxicity in patients presenting with neurological symptoms.

Main Methods:

• Case report of an elderly woman with neurological symptoms.
• Review of patient's medication history, including amoxicillin and metronidazole.
• Brain MRI to identify characteristic neurotoxic findings.
• Discontinuation of metronidazole and monitoring of symptom resolution.

Main Results:

• The patient presented with dizziness, tingling, vomiting, dysarthria, nystagmus, and gait ataxia.
• Brain MRI revealed T2 and FLAIR hyperintensities in the dentate nuclei and splenium of the corpus callosum, consistent with metronidazole neurotoxicity.
• Discontinuation of metronidazole led to symptom resolution, except for persistent lower limb paresthesias.

Conclusions:

• Metronidazole neurotoxicity is a rare adverse effect that warrants consideration, especially with prolonged use.
• Cerebellar dysfunction and polyneuropathy are common manifestations of metronidazole-induced neurotoxicity.
• Early recognition and discontinuation of metronidazole are vital for managing neurotoxic effects.