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Journal of Pediatric Neurology 2021; 19(02): 136-142
DOI: 10.1055/s-0040-1716347
Case Report

Pediatric Metronidazole-Induced Encephalopathy: A Case Report and Review of the Literature

Alberto M. Cappellari 
1   Department of Neuroscience, Fondazione Scientific Institute for Research, Hospitalization and Healthcare Cà Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
,
Donata Rossetti
2   Department of Pediatrics, University of Milan, Milan, Italy
,
Sabrina Avignone
3   Department of Neuroradiology, Fondazione Scientific Institute for Research, Hospitalization and Healthcare Cà Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
,
Elisa Scola
3   Department of Neuroradiology, Fondazione Scientific Institute for Research, Hospitalization and Healthcare Cà Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
,
Antonio Di Cesare
4   Department of Pediatric Surgery, Fondazione Scientific Institute for Research, Hospitalization and Healthcare Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
› Author Affiliations Funding None.
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Abstract

Metronidazole-induced encephalopathy is a rare toxic encephalopathy secondary to the common use to this antimicrobial drug. It has been reported mainly in adult patients but only rarely in children. Owing to possible devastating complication of this disease, clinicians should have a higher index of suspicion for encephalopathic patients on metronidazole therapy. Here, we report a 5-month-old infant with metronidazole-induced encephalopathy presenting with nonconvulsive status epilepticus. A review of the literature in pediatric, as well as adult metronidazole-induced encephalopathy, is also provided.

Keywords

metronidazole - encephalopathy - nonconvulsive status epilepticus


Publication History

Received: 17 June 2020

Accepted: 30 July 2020

Article published online:
31 August 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
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  • References

  • 1 Löfmark S, Edlund C, Nord CE. Metronidazole is still the drug of choice for treatment of anaerobic infections. Clin Infect Dis 2010; 50 (Suppl. 01) S16-S23
    CrossrefPubMedGoogle Scholar
  • 2 Roy U, Panwar A, Pandit A, Das SK, Joshi B. Clinical and neuoradiological spectrum of metronidazole induced encephalopathy: our experience and the review of literature. J Clin Diagn Res 2016; 10 (06) OE01-OE09
    PubMedGoogle Scholar
  • 3 Sørensen CG, Karlsson WK, Amin FM, Lindelof M. Metronidazole-induced encephalopathy: a systematic review. J Neurol 2020; 267 (01) 1-13
    CrossrefPubMedGoogle Scholar
  • 4 Erdener SE, Kansu T, Arsava EM, Dericioglu N. Brain MRI evolution of metronidazole intoxication. Neurology 2013; 80 (19) 1816-1817
    CrossrefPubMedGoogle Scholar
  • 5 Metronidazole (Rx). Accessed August 11, 2020 at: https://reference.medscape.com/drug/flagyl-metronidazole-342566
    PubMedGoogle Scholar
  • 6 Kafadar I, Moustafa F, Yalçın K, Klç BA. A rare adverse effect of metronidazole: nervous system symptoms. Pediatr Emerg Care 2013; 29 (06) 751-752
    CrossrefPubMedGoogle Scholar
  • 7 Omrani A, Rohani M, Hosseinpour S, Tavasoli AR. Persistent dystonia and basal ganglia involvement following metronidazole induced encephalopathy. Neurol Sci 2020; 41 (04) 957-959
    CrossrefPubMedGoogle Scholar
  • 8 Sun Y, Overby PJ, Mehta H. Case 271: metronidazole-induced encephalopathy. Radiology 2019; 293 (02) 473-479
    CrossrefPubMedGoogle Scholar
  • 9 Kuriyama A, Jackson JL, Doi A, Kamiya T. Metronidazole-induced central nervous system toxicity: a systematic review. Clin Neuropharmacol 2011; 34 (06) 241-247
    CrossrefPubMedGoogle Scholar
  • 10 El-Bitar MK, Boustany RM. Common causes of uncommon seizures. Pediatr Neurol 2009; 41 (02) 83-87
    CrossrefPubMedGoogle Scholar
  • 11 Cantador AA, Meschia JF, Freeman WD, Tatum WO. Nonconvulsive status with metronidazole. Neurohospitalist 2013; 3 (04) 185-189
    CrossrefPubMedGoogle Scholar
  • 12 Furukawa S, Yamamoto T, Sugiyama A. et al. Metronidazole-induced encephalopathy with contrast enhancing lesions on MRI. J Neurol Sci 2015; 352 (1-2): 129-131
    CrossrefPubMedGoogle Scholar
  • 13 Sudan YS, Garg A, Gupta R, Bansal AR. Headphone sign: metronidazole-induced encephalopathy. Neurol India 2016; 64 (06) 1374-1376
    CrossrefPubMedGoogle Scholar
  • 14 Hobbs K, Stern-Nezer S, Buckwalter MS, Fischbein N, Finley Caulfield A. Metronidazole-induced encephalopathy: not always a reversible situation. Neurocrit Care 2015; 22 (03) 429-436
    CrossrefPubMedGoogle Scholar
  • 15 Wakisaka K, Morioka T, Shimogawa T. et al. Epileptic ictal hyperperfusion on arterial spin labeling perfusion and diffusion-weighted magnetic resonance images in posterior reversible encephalopathy syndrome. J Stroke Cerebrovasc Dis 2016; 25 (01) 228-237
    CrossrefPubMedGoogle Scholar