Discussion:
Metronidazole can rarely cause central nervous system toxicity. Although
Metronidazole-induced encephalopathy (MIE) is mostly reported from the
United States and Korea, there have been few case reports worldwide
including India, Japan, Australia, Canada, United Kingdom, Belgium,
Chile, Germany, Israel, Netherlands, Nigeria, Taiwan, Tunisia, and
Turkey. Average time taken to develop complications from treatment
initiation is 15 days (range 1-90 days), and the average cumulative dose
is 93.4g (range, 0.25-1095g) 5. MIE can be suspected
in a patient presents cerebellar and brainstem deficits in close
relation to metronidazole treatment 6. T2/FLAIR
hyperintense lesions in the dentate nuclei, are the best diagnostic
finding. In some cases, lesions of the dentate nuclei were not present
initially but revealed on re-imaging 7,8. The majority
of the cases present cerebellar dysfunction (dysarthria, ataxia,
dysmetria, and nystagmus) followed by altered mental status and seizures5, Chorea, myoclonus 9,10 and pure
sensorineural hearing loss are also reported 11. The
patient has also taking methadone and there is reports of toxic
leukoencephalopathy due to methadone 12.
Toxic leukoencephalopathy should be considered in this patients and
suspected drug should be discontinued.
Conflict of interest :
The authors declare there is no conflict of interest.