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KMID : 0988920170150010124
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Intestinal Research
2017 Volume.15 No. 1 p.124 ~ p.129
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Metronidazole-induced encephalopathy in a patient with Crohn's disease
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Kim Ji-Hye
Chun Jae-Young
Park Jae-Yong
Hong Seung-Wook
Lee Joo-Young
Kang Jin-Woo
Hwang Seong-Jun
Ko Sang-Bae
Im Jong-Pil
Kim Joo-Sung
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Abstract
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Metronidazole is a widely used antibiotic for the treatment of anaerobic bacterial infections. Metronidazole-induced encephalopathy (MIEP) is a rare but potentially reversible disease. The mechanism of MIEP remains unclear, and differences in the neurotoxic effects of oral versus intravenous (IV) metronidazole administration have not yet been determined. We report the case of a Crohn's disease (CD) patient who experienced encephalopathy immediately after a single IV dose of metronidazole following long-term exposure to the oral form of the drug. The 64-year-old man with intractable CD experienced a sudden change in mental status, aphasia, and muscle weakness after IV administration of metronidazole. He had previously taken metronidazole orally for 13 years and received intermittent IV metronidazole treatments for CD exacerbation. Brain magnetic resonance imaging (MRI) showed high-intensity signals in the bilateral medial thalamus and the midbrain and pontine tegmentum on fluid-attenuated inversion recovery images. After discontinuation of metronidazole, the high-intensity brain MRI signals resolved and the patient's mental status dramatically improved; however, the patient exhibited mild cognitive dysfunction 2 months after the onset of encephalopathy.
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KEYWORD
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Metronidazole, Drug side effects, Metabolic encephalopathy, Crohn disease
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