Department of Rehabilitation Medicine, School of Medicine, Chungnam National University, Daejeon, Korea.
Department of Biomedical Institute, Chungnam National University, Daejeon, Korea.
Medicine (Baltimore). 2023 Feb 3;102(5):e32788. doi: 10.1097/MD.0000000000032788.
Metronidazole is a 5-nitroimidazole antibiotic effective against anaerobic bacterial and parasitic infections. Long-term use may cause side effects in the central nervous system, although the occurrence of encephalopathy is rare.
A 73-year-old man was diagnosed with acute pyelonephritis and received antibiotic treatment. During the treatment, the patient complained of back pain. Lumbar spinal magnetic resonance imaging (MRI) revealed infective spondylitis, and metronidazole (1.5 g) was administered daily for approximately 160 days. The patient developed cognitive dysfunction and gait disorder after antibiotic treatment, and brain MRI showed acute infarction in both cerebellar lobes. Secondary prevention with antiplatelet and physiotherapy was prescribed; however, functional recovery was not achieved.
After 1 month, a follow-up brain MRI showed high signal intensity and diffusion restriction in the corpus callosum on diffusion-weighted images and high signal intensity in the dentate nucleus on T2-weighted images. Therefore, metronidazole-induced encephalopathy was suspected.
Metronidazole was discontinued, and ceftriaxone (2 g/day) was administered to manage the infective spondylitis.
One week after the discontinuation of the drug, the patient's cognition improved to the extent that communication was possible. Thus, even if other neurological deficits, such as cerebellar infarction, are found in patients with long-term disability, the possibility of metronidazole-induced encephalopathy should be considered when metronidazole is used for a long time.
甲硝唑是一种 5-硝基咪唑类抗生素，对厌氧细菌和寄生虫感染有效。长期使用可能会引起中枢神经系统的副作用，尽管脑病的发生较为罕见。
一名 73 岁男性被诊断为急性肾盂肾炎并接受了抗生素治疗。在治疗过程中，患者出现背痛。腰椎磁共振成像（MRI）显示感染性脊椎炎，每天给予甲硝唑（1.5 g）治疗约 160 天。抗生素治疗后，患者出现认知功能障碍和步态障碍，脑部 MRI 显示两侧小脑叶急性梗死。给予抗血小板和物理治疗进行二级预防；然而，功能并未恢复。
1 个月后，复查脑部 MRI 显示在弥散加权图像上胼胝体弥散受限和高信号，在 T2 加权图像上齿状核高信号，因此怀疑为甲硝唑引起的脑病。
停用甲硝唑，给予头孢曲松（2 g/天）治疗感染性脊椎炎。
停药 1 周后，患者的认知功能有所改善，可以进行交流。因此，即使在长期残疾的患者中发现其他神经功能缺损，如小脑梗死，在长期使用甲硝唑时也应考虑甲硝唑引起的脑病的可能性。
