Metronidazole-Induced Encephalopathy in a Patient with End-Stage Liver Disease
Open Access
- 17 December 2012
- journal article
- case report
- Published by Hindawi Limited in Case Reports in Hepatology
- Vol. 2012, 1-4
- https://doi.org/10.1155/2012/209258
Abstract
Purpose. Metronidazole-induced encephalopathy (MIE) has been rarely reported. We report a case in a patient with end-stage liver disease (ESLD).Summary. A 63-year-old male with ESLD secondary to hepatitis C virus presented with progressively worsening fatigue, slurred speech, aphasia, vomiting, and left-sided facial droop after completing a 2-week course of metronidazole for recurrentClostridium difficile-associated diarrhea. He completed a previous course of metronidazole 3 weeks prior to presentation. He is on the liver transplant waiting list and has known hepatic encephalopathy. MRI revealed hyperintense T2 signals involving the bilateral dentate nuclei, inferior colliculi and splenium of the corpus callosum, and increased diffusion restriction at the splenium of the corpus callosum. His neurological function improved over the next several days. He underwent liver transplantation 6 days after admission. A follow-up MRI 6 weeks after presentation revealed resolution of abnormalities; however, paresthesias persisted 6 months after MIE diagnosis.Conclusion. An ESLD patient with hepatic encephalopathy developed MIE after a relatively short course of metronidazole. Metronidazole has been shown to accumulate in patients with ESLD. Increased awareness for neurotoxicity when using metronidazole in ESLD patients is warranted, especially in those with potentially confounding hepatic encephalopathy.Keywords
This publication has 20 references indexed in Scilit:
- Metronidazole-induced encephalopathy in a patient with infectious colitis: a case reportJournal of Medical Case Reports, 2011
- Metronidazole-induced encephalopathy in a patient with liver cirrhosisThe Korean Journal of Hepatology, 2011
- Metronidazole-Induced encephalopathy: a Case Report and Review of the LiteratureThe Journal of Clinical Pharmacology, 2011
- Mechanisms, diagnosis and management of hepatic encephalopathyNature Reviews Gastroenterology & Hepatology, 2010
- Metronidazole Induced Encephalopathy in a Patient with Brain AbscessJournal of Korean Neurosurgical Society, 2010
- Movement disorders as a manifestation of metronidazole-induced encephalopathy in a patient with chronic liver diseaseMovement Disorders, 2009
- MR Imaging Findings in Hepatic EncephalopathyAmerican Journal Of Neuroradiology, 2008
- Diazepam as a Treatment for Metronidazole Toxicosis in Dogs: A Retrospective Study of 21 CasesJournal of Veterinary Internal Medicine, 2003
- Metronidazole Pharmacokinetics in Patients with Hepatic EncephalopathyScandinavian Journal of Gastroenterology, 1987
- Clinical Pharmacokinetics of MetronidazoleClinical Pharmacokinetics, 1983