Metronidazole induced cerebellar toxicity after prolonged treatment of large multiloculated pyogenic liver abscess; A case report and literature review

Metronidazole is a common antibiotic agent for hepatic abscesses, which require both gram-negative and anaerobic coverage. Rarely, this antibiotic has been found to induce encephalopathy. Here, we describe a 65-year-old male who was treated with metronidazole for his hepatic abscess, who presented w...

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Main Authors: Ahmed Salem, William Lewis, Brooke Kania, Deniz Yucel, Muhammad Yusuf Kahf, Christopher Millet
Format: Article
Language:English
Published: Elsevier 2023-01-01
Series:IDCases
Subjects:
Online Access:http://www.sciencedirect.com/science/article/pii/S2214250923000070
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author Ahmed Salem
William Lewis
Brooke Kania
Deniz Yucel
Muhammad Yusuf Kahf
Christopher Millet
author_facet Ahmed Salem
William Lewis
Brooke Kania
Deniz Yucel
Muhammad Yusuf Kahf
Christopher Millet
author_sort Ahmed Salem
collection DOAJ
description Metronidazole is a common antibiotic agent for hepatic abscesses, which require both gram-negative and anaerobic coverage. Rarely, this antibiotic has been found to induce encephalopathy. Here, we describe a 65-year-old male who was treated with metronidazole for his hepatic abscess, who presented with syncope and questionable seizure and was found to have magnetic resonance imaging (MRI) brain findings consistent with metronidazole toxicity. Our patient demonstrated striking brain MRI findings which can be used to further understand the process behind this medication-induced toxicity. Hypotheses of this mechanism include swelling of axons secondary to increased water or vasospasm leading to reversible ischemia that is localized in the brain. In terms of MRI findings, brain lesions tend to populate bilaterally with focus at the dorsal pons, midbrain, cerebellar dentate nuclei (as with our patient), dorsal medulla, or splenium of corpus callosum. Additional research is warranted regarding this rare manifestation and timely removal of the offending agent is crucial for reversal of symptoms.
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spelling doaj.art-73210136024e4bfcbb93266b964335e52023-03-16T05:04:29ZengElsevierIDCases2214-25092023-01-0131e01683Metronidazole induced cerebellar toxicity after prolonged treatment of large multiloculated pyogenic liver abscess; A case report and literature reviewAhmed Salem0William Lewis1Brooke Kania2Deniz Yucel3Muhammad Yusuf Kahf4Christopher Millet5Correspondence to: Internal Medicine Resident, Saint Joseph University Medical Center, 703 Main Street, Paterson, NJ 07503, USA.; Internal Medicine Department, Saint Joseph's University Medical Center, Paterson, NJ, USAInternal Medicine Department, Saint Joseph's University Medical Center, Paterson, NJ, USAInternal Medicine Department, Saint Joseph's University Medical Center, Paterson, NJ, USAInternal Medicine Department, Saint Joseph's University Medical Center, Paterson, NJ, USAInternal Medicine Department, Saint Joseph's University Medical Center, Paterson, NJ, USAInternal Medicine Department, Saint Joseph's University Medical Center, Paterson, NJ, USAMetronidazole is a common antibiotic agent for hepatic abscesses, which require both gram-negative and anaerobic coverage. Rarely, this antibiotic has been found to induce encephalopathy. Here, we describe a 65-year-old male who was treated with metronidazole for his hepatic abscess, who presented with syncope and questionable seizure and was found to have magnetic resonance imaging (MRI) brain findings consistent with metronidazole toxicity. Our patient demonstrated striking brain MRI findings which can be used to further understand the process behind this medication-induced toxicity. Hypotheses of this mechanism include swelling of axons secondary to increased water or vasospasm leading to reversible ischemia that is localized in the brain. In terms of MRI findings, brain lesions tend to populate bilaterally with focus at the dorsal pons, midbrain, cerebellar dentate nuclei (as with our patient), dorsal medulla, or splenium of corpus callosum. Additional research is warranted regarding this rare manifestation and timely removal of the offending agent is crucial for reversal of symptoms.http://www.sciencedirect.com/science/article/pii/S2214250923000070Metronidazole toxicityKlebsiella pneumoniae Hepatic abscessMRI brainCerebellar dentate nuclei
spellingShingle Ahmed Salem
William Lewis
Brooke Kania
Deniz Yucel
Muhammad Yusuf Kahf
Christopher Millet
Metronidazole induced cerebellar toxicity after prolonged treatment of large multiloculated pyogenic liver abscess; A case report and literature review
IDCases
Metronidazole toxicity
Klebsiella pneumoniae Hepatic abscess
MRI brain
Cerebellar dentate nuclei
title Metronidazole induced cerebellar toxicity after prolonged treatment of large multiloculated pyogenic liver abscess; A case report and literature review
title_full Metronidazole induced cerebellar toxicity after prolonged treatment of large multiloculated pyogenic liver abscess; A case report and literature review
title_fullStr Metronidazole induced cerebellar toxicity after prolonged treatment of large multiloculated pyogenic liver abscess; A case report and literature review
title_full_unstemmed Metronidazole induced cerebellar toxicity after prolonged treatment of large multiloculated pyogenic liver abscess; A case report and literature review
title_short Metronidazole induced cerebellar toxicity after prolonged treatment of large multiloculated pyogenic liver abscess; A case report and literature review
title_sort metronidazole induced cerebellar toxicity after prolonged treatment of large multiloculated pyogenic liver abscess a case report and literature review
topic Metronidazole toxicity
Klebsiella pneumoniae Hepatic abscess
MRI brain
Cerebellar dentate nuclei
url http://www.sciencedirect.com/science/article/pii/S2214250923000070
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