Mizuta Kazutaka, Sonohata Motoki, Nozaki Osamu, Kobatake Tomoki, Nakayama Daisuke, Morimoto Tadatsugu, Mawatari Masaaki
Department of Orthopaedic Surgery, Yanagawa Hospital, 29 Chikushi-machi, Yanagawa, 832-0077, Japan.
Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan.
BMC Musculoskelet Disord. 2018 Sep 18;19(1):336. doi: 10.1186/s12891-018-2255-8.
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. At 14 days after discontinuation of oral metronidazole, abnormal findings on diffusion-weighted imaging almost disappeared.
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.
甲硝唑是一种常用于治疗多种原生动物和厌氧菌感染的抗菌药物。与甲硝唑相关的神经毒性鲜有报道，甲硝唑诱发脑病的发病率也未知。因此，由于该病罕见，甲硝唑诱发脑病的准确诊断往往很困难。
一名86岁女性患有腰椎化脓性脊柱炎。活检标本中鉴定出微小微单胞菌，这是一种革兰氏阳性厌氧细菌，也是口腔菌群的常住菌。开始口服甲硝唑（1500毫克/天）。在开始使用甲硝唑44天后（总摄入量66克），她抱怨上肢有刺痛感。4天后，她又出现了其他症状，包括舌头感觉障碍、构音障碍和吞咽障碍。T2加权液体衰减反转恢复序列和扩散加权成像上典型的脑磁共振成像表现导致了甲硝唑诱发脑病的诊断。停用甲硝唑，停药10天后她的神经症状有所改善。在停用口服甲硝唑14天后，扩散加权成像上的异常表现几乎消失。
鉴于在骨科领域治疗各种感染时可能需要开具甲硝唑，骨科医生很可能会遇到甲硝唑诱发脑病的病例。因此，他们应该能够识别这种情况及其潜在并发症。随着认识的提高，当转诊此类患者时，通过磁共振成像进行早期诊断并停用甲硝唑可能变得可行。我们的报告详细描述了这样一个病例，这可能有助于甲硝唑诱发脑病患者的早期诊断和治疗。此外，我们建议接受甲硝唑治疗的患者在开始抗生素治疗后应接受仔细且持续的监测。
