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Metronidazole-induced cerebellar dysfunction: An underdiagnosed identity
Aditya Debuka1, Manaswi Chaubey1, Shubh N T Rai1
1Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India.
Abstract:
Metronidazole is a commonly used antibiotic in clinical practice. It is associated with neurological toxicity if used for a longer duration or at a higher dose. In our case, the patient was prescribed metronidazole for the treatment of amoebic liver abscess for 7 weeks and he developed metronidazole-induced cerebellar dysfunction and small fibre peripheral neuropathy. Characteristic MRI findings, temporal association of symptoms with drug and resolution on drug withdrawal helped to make the diagnosis. Our case highlights the need of avoidance of prolonged administration of metronidazole and advocates alternative methods including percutaneous drainage to be adopted for a nonresolving liver abscess.
Insights
Prolonged use of metronidazole for amoebic liver abscess can cause neurological damage, including cerebellar dysfunction and neuropathy. Alternative treatments should be considered for persistent abscesses to avoid these adverse effects.
Area of Science:
- Neurology
- Infectious Diseases
- Pharmacology
Background:
- Metronidazole is a widely prescribed antibiotic for various infections.
- Prolonged or high-dose use of metronidazole is linked to potential neurological toxicity.
- Amoebic liver abscesses often require extended treatment courses.
Observation:
- A patient treated for an amoebic liver abscess with metronidazole for seven weeks developed neurological complications.
- The patient exhibited symptoms of cerebellar dysfunction and small fiber peripheral neuropathy.
- Magnetic resonance imaging (MRI) revealed characteristic findings consistent with drug-induced toxicity.
Findings:
- The observed neurological symptoms were temporally associated with metronidazole administration.
- Cessation of metronidazole led to the resolution of the patient's symptoms.
- This case confirms metronidazole-induced cerebellar dysfunction and peripheral neuropathy.
Implications:
- Clinicians should exercise caution regarding the duration of metronidazole therapy.
- Consideration of alternative treatments, such as percutaneous drainage, is recommended for non-resolving amoebic liver abscesses.
- Awareness of metronidazole's neurotoxic potential is crucial for patient safety.
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