Metronidazole-Induced Encephalopathy in a Patient with End-Stage Liver Disease. (17th December 2012)

• Record Type: Journal Article
• Authors: Knorr, John P.; Javed, Imran; Sahni, Neha; Cankurtaran, Ceylan Z.; Ortiz, Jorge A.
• Other Names: Chebli J. M. F. Academic Editor.; Imazeki F. Academic Editor.; Koike N. Academic Editor.; Koskinas J. S. Academic Editor.; Pérez Roldán F. Academic Editor.
• Is Part Of: Case reports in hepatology. Volume 2012(2012)
• Publication Date: 2012-12-17
• Subjects: Liver -- Periodicals; Liver -- Diseases -- Periodicals; Liver Diseases; Liver; Liver; Liver -- Diseases; Periodicals; Periodicals; Case Reports; Fulltext; Internet Resources; Periodicals; 616.36
• DOI: 10.1155/2012/209258
• Languages: English
• ISSNs: 2090-6587

Abstract

Abstract : Purpose . Metronidazole-induced encephalopathy (MIE) has been rarely reported. We report a case in a patient with end-stage liver disease (ESLD). Summary . A 63-year-old male with ESLD secondary to hepatitis C virus presented with progressively worsening fatigue, slurred speech, aphasia, vomiting, and left-sided facial droop after completing a 2-week course of metronidazole for recurrent Clostridium difficile -associated diarrhea. He completed a previous course of metronidazole 3 weeks prior to presentation. He is on the liver transplant waiting list and has known hepatic encephalopathy. MRI revealed hyperintense T2 signals involving the bilateral dentate nuclei, inferior colliculi and splenium of the corpus callosum, and increased diffusion restriction at the splenium of the corpus callosum. His neurological function improved over the next several days. He underwent liver transplantation 6 days after admission. A follow-up MRI 6 weeks after presentation revealed resolution of abnormalities; however, paresthesias persisted 6 months after MIE diagnosis. Conclusion . An ESLD patient with hepatic encephalopathy developed MIE after a relatively short course of metronidazole. Metronidazole has been shown to accumulate in patients with ESLD. Increased awareness for neurotoxicity when using metronidazole in ESLD patients is warranted, especially in those with potentially confounding hepatic encephalopathy.