Metronidazole-induced encephalopathy in a patient with pyogenic spondylitis: a case report

BMC Musculoskeletal Disorders
Kazutaka MizutaMasaaki Mawatari

Abstract

Metronidazole is an antimicrobial agent commonly used in the treatment of several protozoal and anaerobic infections. Neurotoxicity associated with metronidazole has been rarely reported, and the incidence of metronidazole-induced encephalopathy is unknown. Therefore, the accurate diagnosis of metronidazole-induced encephalopathy is often difficult because of the rarity of the disease. An 86-year-old woman suffered from pyogenic spondylitis of the lumbar spine. Parvimonas micra, a gram-positive anaerobic bacterial species and a resident of the flora of the oral cavity, was identified in the biopsy specimens. Oral administration of metronidazole (1500 mg/day) was initiated. Forty-four days after initiating metronidazole (total intake of 66 g), she complained of tingling sensations in the upper limbs. After 4 days, she complained of additional symptoms including sensory disturbance of the tongue, dysarthria, and deglutition disorder. Characteristic brain magnetic resonance imaging findings on T2-weighted fluid-attenuated inversion recovery and diffusion-weighted imaging led to the diagnosis of metronidazole-induced encephalopathy. Metronidazole was discontinued, and her neurological symptoms improved 10 days after discontinuation...Continue Reading

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Citations

Mar 6, 2019·Postgraduate Medical Journal·Tatsuya UenoMasahiko Tomiyama
Dec 12, 2018·Journal of Neurology·Caspar Godthaab SørensenMette Lindelof
Jul 20, 2019·CNS Drugs·Madison K Bangert, Rodrigo Hasbun

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Methods Mentioned

BETA
biopsy

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