Abstract
In hospitals, seizures and encephalopathy are one of the common complications observed
in critically ill patients. Drug intoxication, metabolic derangements, and anatomical
abnormalities can cause altered mental status. We encountered an uncommon case with
a diagnostic dilemma due to persistent encephalopathy, where metronidazole toxicity
was an etiological factor. A 45-year-old male, who was admitted with the diagnosis
of ruptured amoebic liver abscess. During the course of his management, he developed
seizures and altered sensorium. After excluding other etiologies for in-hospital de
novo seizure, a suspicion of metronidazole toxicity was considered. MRI brain was
done which suggested the same. Metronidazole induced encephalopathy (MIE) is an uncommon
adverse effect of treatment with metronidazole. Diagnosis is made by identifying specific
radiological findings. It characteristically affects the cerebellum and subcortical
structures. While the clinical and neuroimaging changes are usually reversible, persistent
encephalopathy with poor outcomes may occur as seen in our case.
Keywords
Encephalopathy - metronidazole - seizure
