1. A METRONIDAZOLE ENCEPHALOPATHY IN A PATIENT WITH CULTURE NEGATIVE BRAIN ABSCESS
- Author
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I. Kanami, N. Ohtake, J. Numata, J. Tsurukiri, and Y. Hirai
- Subjects
Infectious and parasitic diseases ,RC109-216 - Abstract
Intro: Background: Metronidazole (MNZ) is a widely used antibiotic against anaerobic and parasitic infections due to its efficiency and safety with penetration to the central nervous system (CNS). MNZ-induced encephalopathy (MIE) is recognized as a rare adverse event. Methods: Case description of a 40-year-old-man, with depression, presented with altered mental status and agitation for past two days before hospitalization. The patient found to have aphasia on examination. No meningeal sign found. Blood culture taken at admission was negative. However multiple brain abscess was found in magnetic resonance imaging (MRI). Intravenous MNZ (500mg TID) combined with vancomycin (1.5g BID) and ceftriaxone (2g BID) were administered empirically for 6 weeks as bacterial brain abscess. No pathogen was also identified from fluid by drainage. Antimicrobial treatment was switched to oral MNZ with Sulfamethoxazole-Trimethoprim for 4 weeks. During the followup, the patient developed dizziness and physical examination showed symptoms of cerebella ataxia. MIE was confirmed according to symmetrical hyperintensity in the dentate nuclei of cerebellum on both T2 and FLAIR image as a ‘boomerang-sign’ on brain MRI. The symptom was improved within 2 weeks followed by discontinuation of oral MNZ. One month later, MRI showed complete resolution of the MIE features as well as diminishing of brain abscess. Amount dose of MNZ administered was 105g.
- Published
- 2023
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