Peripheral neuropathy as a rare syndrome related to metronidazole usage: Metronidazole may lead to persistent neuropathy

Abstract

Metronidazole is a potent drug used against some protozoa like Entamoeba histolytica, Giardia lamblia, Trichomonas vaginalis and Balantidium coli, and anaerobic bacteria. It is used for the treatment of alcoholism, Crohn’s disease, exophthalmos, rheumatoid arthritis, rosea and acne as well. It is a well-tolerated drug with some kinds of side effects like abdominal pain, headache, nausea and metallic taste. Rarely but severely, pseudomembranous colitis, epileptic seizure, encephalopathy and peripheral neuropathy might be seen. These side effects are generally self-limited. Drug administration should be stopped immediately in case of these side effects’ existence. In this article, we presented a case which used metronidazole for hepatic ameobiasis in a time period of 4 and a half months, and developed peripheral neuropathy.

Keywords

• Adverse effect; ameobiasis; metronidazole; peripheral neuropathy

References

1. Rustscheff S, Hulten S. An unexpected and severe neurological disorder with permanent disability acquired during short course treatment with metronidazole. Scand J Infect Dis 2003; 53:279-280.
2. Goodwin, D W, and Reinhard, J, Quarterly J'ournal of Studies of Alcohol. 1972, 33, 734.
3. Ozturk F, Burakgazi G, Akyol M. Metronidazole-induced encephalopathy in a patient with pons abscess: a case report. Abant Med J 2015; 4(3):293-294.
4. Park KI, Chung JM, Kim JY. Metronidazole neurotoxicity: sequential neuroaxis involvement. Neurol India. 2011; 59(1):104-107.
5. Cantador AA, Meschia JF, Freeman WD and Tatum WO. Nonconvulsive status with metronidazole. Neurohospitalist. 2013; 3(4):185-189.
6. Retamal-Riquelme E, Soto-San Martín H, Vallejos-Castro J, Galdames-Poblete D. Reversible neurotoxicity secondary to metronidazole: report of one case. RevMed Chil. 2014 Mar;142(3):386-390.
7. Heaney CJ, Campeau NG, and Lindell EP: MR imaging and diffusion-weighted imaging changes in metronidazole (Flagyl)-induced cerebellar toxicity, AJNR Am J Neuroradiol 2003; 24(8):1615-1617.
8. Boyce EG, Cookson ET, and Bond WS: Persistent metronidazole - induced peripheral neuropathy. DICP 1990; 24:19-21.

9. Takeuchi H, Yamada A, Touge T et al: Metronidazole neuropathy - a case report. Japanese Journal of Psychiatry and Neurology 1988; 42:291-295.
10. Bradley WG, Karlsson IJ, and Rassol CG: Metronidazole neuropathy, Br Med J 1977; 2(6087):610-611.
11. Pais P, Balasubramaniam KR: Metronidazole-peripheral neuropathy, J Assoc Physicians India 1982; 30(12):918-919.
12. Sarma GR, Kamath V: Acute painful peripheral neuropathy due to metronidazole, Neurol India 2005; 53(3):372-373.
13. Duffy LF, Daum F, Fisher SE et al: Peripheral neuropathy in Crohn’s disease patients treated with metronidazole, Gastroenterology 1985; 88(3):681-684.
14. Turan H, Horasanlı B, Şerefhanoğlu K, Ünler GK, Timurkaynak F, Arslan H: Peripheral Neuropathy Due to Metronidazole Treatment, ANKEM Derg 2007;21(2):98-100.