Sahu Partha, Sharma Nivedita, Panda Prasan Kumar, Pilania Jaideep
General Medicine (ID Division), All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India.
Radiodiagnosis, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India.
BMJ Case Rep. 2025 Apr 22;18(4):e264913. doi: 10.1136/bcr-2025-264913.
Though effective, metronidazole poses multiple side effects, especially with prolonged therapy or high dosage. Among these are metronidazole-induced peripheral neuropathy and encephalopathy, which are severely debilitating. We describe a middle-aged man with a liver abscess who was treated with metronidazole 2.4 g/day for nearly 2 months, and who went on to develop dysarthria, ataxic gait and sensory loss, including numbness and burning paraesthesia in his limbs. Neurological assessment comprised nerve conduction studies (NCS) and magnetic resonance imaging (MRI). NCS indicated axonal neuropathy, and MRI revealed T2/FLAIR hyperintensities in the dentate nuclei and corpus callosum, which are indicative of toxic encephalopathy. Symptoms improved considerably after metronidazole was stopped. This case documents the possibility of metronidazole-induced severe neurological sequelae, such as peripheral neuropathy and encephalopathy, especially with high doses (140 gm) or prolonged therapy. Clinicians must remain vigilant for evidence of neurotoxicity in metronidazole-treated patients, especially those on prolonged or high-dose therapy.
尽管甲硝唑有效，但它会引发多种副作用，尤其是在长期治疗或高剂量使用时。其中包括甲硝唑引起的周围神经病变和脑病，这些会使人严重衰弱。我们描述了一名患有肝脓肿的中年男子，他接受了每天2.4克甲硝唑的治疗，持续了近2个月，随后出现了构音障碍、共济失调步态和感觉丧失，包括四肢麻木和烧灼样感觉异常。神经学评估包括神经传导研究（NCS）和磁共振成像（MRI）。NCS显示为轴索性神经病变，MRI显示齿状核和胼胝体T2/液体衰减反转恢复序列（FLAIR）高信号，这表明存在中毒性脑病。停用甲硝唑后症状有明显改善。该病例证明了甲硝唑会导致严重神经后遗症的可能性，如周围神经病变和脑病，尤其是在高剂量（140克）或长期治疗时。临床医生必须对接受甲硝唑治疗的患者，尤其是那些接受长期或高剂量治疗的患者的神经毒性证据保持警惕。
