Metronidazole Case Report

METRONIDAZOLE TOXICITY PRESENTING AS ACUTE CEREBELLAR SYNDROME; A CASE REPORT
ABSTRACT
A young male presented to us with features of acute cerebellar syndrome. He was a diagnosed case of liver abscess but was lost to follow up. He had continued taking medicines for liver abscess well beyond the prescribed duration. The MRI brain of the patient showed hyper-intensities in bilateral dentate nuclei on T2 FLAIR images, suggestive of Metabolic Encephalopathy. On stopping metronidazole, patient showed recovery in one week.

BACKGROUND Metronidazole is a very commonly used antibiotic for bacterial and protozoal infections. The drug causes a variety of neurological side effects-ranging from mild giddiness to frank Encephalopathy. Metronidazole is an imidazole antibiotic that is used for the treatment of protozoal, bacterial and various parasitic infections. Metronidazole acts by disturbing the DNA machinery of the cell. It crosses blood brain barrier and diffuses to the neurons. It interferes with the RNA protein machinery of the neurons leading to the disruption of the cytoskeleton of axon and swelling.
Here we are presenting a case of liver abscess that developed acute cerebellar syndrome due to metronidazole.

Patient NCCT brain was normal study. Patient’s emergency hematological and biochemical investigations were unremarkable. On hepatobiliary system ultrasonography, there was still a liver abscess of 50 cc. Patient’s liver function tests showed hyperbilirubinemia with normal liver enzymes. In the workup of his jaundice, he found to be Hbs Ag positive. On further analysis, HBeAg was negative and HBV DNA was undetectable. Patient’s folic acid and vitamin B12 levels were in normal limit. Serum serologies for common viruses (HSV, Measles, mumps, enterovirus) were negative. To solve this dilemma lumber puncture done. But results were