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

Abstract Background 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 accurat...

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Main Authors: Kazutaka Mizuta, Motoki Sonohata, Osamu Nozaki, Tomoki Kobatake, Daisuke Nakayama, Tadatsugu Morimoto, Masaaki Mawatari
Format: Article
Language:English
Published: BMC 2018-09-01
Series:BMC Musculoskeletal Disorders
Subjects:
Online Access:http://link.springer.com/article/10.1186/s12891-018-2255-8
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spelling doaj-f68747da729c4343abaec072410c21962020-11-24T22:12:33ZengBMCBMC Musculoskeletal Disorders1471-24742018-09-011911510.1186/s12891-018-2255-8Metronidazole-induced encephalopathy in a patient with pyogenic spondylitis: a case reportKazutaka Mizuta0Motoki Sonohata1Osamu Nozaki2Tomoki Kobatake3Daisuke Nakayama4Tadatsugu Morimoto5Masaaki Mawatari6Department of Orthopaedic Surgery, Yanagawa HospitalDepartment of Orthopaedic Surgery, Faculty of Medicine, Saga UniversityDepartment of Orthopaedic Surgery, Yanagawa HospitalDepartment of Orthopaedic Surgery, Yanagawa HospitalDepartment of Orthopaedic Surgery, Yanagawa HospitalDepartment of Orthopaedic Surgery, Faculty of Medicine, Saga UniversityDepartment of Orthopaedic Surgery, Faculty of Medicine, Saga UniversityAbstract Background 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. Case presentation 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. At 14 days after discontinuation of oral metronidazole, abnormal findings on diffusion-weighted imaging almost disappeared. Conclusions With the possibility of needing to prescribe metronidazole in the orthopedic field for the treatment of various infections, orthopedic surgeons are likely to encounter cases of metronidazole-induced encephalopathy. Thus, they should be able to recognize the condition and its potential complications. With increased awareness, early diagnosis with magnetic resonance imaging and discontinuation of metronidazole may become feasible when such patients are referred. Our report presents a detailed account of such a case, which may help in the early diagnosis and treatment of patients with metronidazole-induced encephalopathy. Furthermore, we recommend that patients treated with metronidazole should undergo careful and constant surveillance after starting antibiotic therapy.http://link.springer.com/article/10.1186/s12891-018-2255-8Metronidazole-induced encephalopathyAntimicrobialComplicationMagnetic resonance imaging
collection DOAJ
language English
format Article
sources DOAJ
author Kazutaka Mizuta
Motoki Sonohata
Osamu Nozaki
Tomoki Kobatake
Daisuke Nakayama
Tadatsugu Morimoto
Masaaki Mawatari
spellingShingle Kazutaka Mizuta
Motoki Sonohata
Osamu Nozaki
Tomoki Kobatake
Daisuke Nakayama
Tadatsugu Morimoto
Masaaki Mawatari
Metronidazole-induced encephalopathy in a patient with pyogenic spondylitis: a case report
BMC Musculoskeletal Disorders
Metronidazole-induced encephalopathy
Antimicrobial
Complication
Magnetic resonance imaging
author_facet Kazutaka Mizuta
Motoki Sonohata
Osamu Nozaki
Tomoki Kobatake
Daisuke Nakayama
Tadatsugu Morimoto
Masaaki Mawatari
author_sort Kazutaka Mizuta
title Metronidazole-induced encephalopathy in a patient with pyogenic spondylitis: a case report
title_short Metronidazole-induced encephalopathy in a patient with pyogenic spondylitis: a case report
title_full Metronidazole-induced encephalopathy in a patient with pyogenic spondylitis: a case report
title_fullStr Metronidazole-induced encephalopathy in a patient with pyogenic spondylitis: a case report
title_full_unstemmed Metronidazole-induced encephalopathy in a patient with pyogenic spondylitis: a case report
title_sort metronidazole-induced encephalopathy in a patient with pyogenic spondylitis: a case report
publisher BMC
series BMC Musculoskeletal Disorders
issn 1471-2474
publishDate 2018-09-01
description Abstract Background 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. Case presentation 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. At 14 days after discontinuation of oral metronidazole, abnormal findings on diffusion-weighted imaging almost disappeared. Conclusions With the possibility of needing to prescribe metronidazole in the orthopedic field for the treatment of various infections, orthopedic surgeons are likely to encounter cases of metronidazole-induced encephalopathy. Thus, they should be able to recognize the condition and its potential complications. With increased awareness, early diagnosis with magnetic resonance imaging and discontinuation of metronidazole may become feasible when such patients are referred. Our report presents a detailed account of such a case, which may help in the early diagnosis and treatment of patients with metronidazole-induced encephalopathy. Furthermore, we recommend that patients treated with metronidazole should undergo careful and constant surveillance after starting antibiotic therapy.
topic Metronidazole-induced encephalopathy
Antimicrobial
Complication
Magnetic resonance imaging
url http://link.springer.com/article/10.1186/s12891-018-2255-8
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