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Metronidazole, an Uncommon Cause of Dizziness and Ataxia in the Emergency Department: A Case Report

INTRODUCTION: Metronidazole, a nitroimidazole antibiotic, is a well-known antibacterial and antiprotozoal agent that is generally well tolerated without many serious side effects. Most adverse reactions affect the gastrointestinal or genitourinary system, but the central nervous system may also be a...

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Autores principales: Starrs, Mary E., Yenigun, Onur M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: University of California Irvine, Department of Emergency Medicine publishing Western Journal of Emergency Medicine 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8143839/
https://www.ncbi.nlm.nih.gov/pubmed/34437014
http://dx.doi.org/10.5811/cpcem.2021.3.52046
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author Starrs, Mary E.
Yenigun, Onur M.
author_facet Starrs, Mary E.
Yenigun, Onur M.
author_sort Starrs, Mary E.
collection PubMed
description INTRODUCTION: Metronidazole, a nitroimidazole antibiotic, is a well-known antibacterial and antiprotozoal agent that is generally well tolerated without many serious side effects. Most adverse reactions affect the gastrointestinal or genitourinary system, but the central nervous system may also be afflicted. In addition to headache and dizziness, cerebellar dysfunction can occur with metronidazole use. CASE REPORT: We discuss the clinical presentation and imaging findings of metronidazole-induced encephalopathy in a 12-year-old male. The patient had a history of Crohn’s disease and chronic Clostridium difficile infection for which he had received metronidazole for approximately 75 days prior to arrival to a local emergency department (ED). He presented with five days of progressive vertigo, nausea, vomiting, and ataxia. Subsequent magnetic resonance imaging showed symmetric hyperintense dentate nuclei lesions, characteristic of metronidazole-induced encephalopathy. The patient’s symptoms improved rapidly after cessation of metronidazole, and his symptoms had completely resolved by discharge on hospital day two. CONCLUSION: Metronidazole-induced encephalopathy is a rare cause of vertigo and ataxia that can lead to permanent sequela if not identified and treated promptly. Thus, it is important for physicians to keep this diagnosis in mind when evaluating patients on metronidazole who present to the ED with new neurologic complaints.
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spelling pubmed-81438392021-05-28 Metronidazole, an Uncommon Cause of Dizziness and Ataxia in the Emergency Department: A Case Report Starrs, Mary E. Yenigun, Onur M. Clin Pract Cases Emerg Med Case Report INTRODUCTION: Metronidazole, a nitroimidazole antibiotic, is a well-known antibacterial and antiprotozoal agent that is generally well tolerated without many serious side effects. Most adverse reactions affect the gastrointestinal or genitourinary system, but the central nervous system may also be afflicted. In addition to headache and dizziness, cerebellar dysfunction can occur with metronidazole use. CASE REPORT: We discuss the clinical presentation and imaging findings of metronidazole-induced encephalopathy in a 12-year-old male. The patient had a history of Crohn’s disease and chronic Clostridium difficile infection for which he had received metronidazole for approximately 75 days prior to arrival to a local emergency department (ED). He presented with five days of progressive vertigo, nausea, vomiting, and ataxia. Subsequent magnetic resonance imaging showed symmetric hyperintense dentate nuclei lesions, characteristic of metronidazole-induced encephalopathy. The patient’s symptoms improved rapidly after cessation of metronidazole, and his symptoms had completely resolved by discharge on hospital day two. CONCLUSION: Metronidazole-induced encephalopathy is a rare cause of vertigo and ataxia that can lead to permanent sequela if not identified and treated promptly. Thus, it is important for physicians to keep this diagnosis in mind when evaluating patients on metronidazole who present to the ED with new neurologic complaints. University of California Irvine, Department of Emergency Medicine publishing Western Journal of Emergency Medicine 2021-05-10 /pmc/articles/PMC8143839/ /pubmed/34437014 http://dx.doi.org/10.5811/cpcem.2021.3.52046 Text en Copyright: © 2021 Starrs et al. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) License. See: http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/)
spellingShingle Case Report
Starrs, Mary E.
Yenigun, Onur M.
Metronidazole, an Uncommon Cause of Dizziness and Ataxia in the Emergency Department: A Case Report
title Metronidazole, an Uncommon Cause of Dizziness and Ataxia in the Emergency Department: A Case Report
title_full Metronidazole, an Uncommon Cause of Dizziness and Ataxia in the Emergency Department: A Case Report
title_fullStr Metronidazole, an Uncommon Cause of Dizziness and Ataxia in the Emergency Department: A Case Report
title_full_unstemmed Metronidazole, an Uncommon Cause of Dizziness and Ataxia in the Emergency Department: A Case Report
title_short Metronidazole, an Uncommon Cause of Dizziness and Ataxia in the Emergency Department: A Case Report
title_sort metronidazole, an uncommon cause of dizziness and ataxia in the emergency department: a case report
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8143839/
https://www.ncbi.nlm.nih.gov/pubmed/34437014
http://dx.doi.org/10.5811/cpcem.2021.3.52046
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