Metronidazole-induced encephalopathy in a patient with Crohn's disease
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) me...
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doaj-d117b34980b847bf859297d1c75754f32020-11-24T22:58:00ZengKorean Association for the Study of Intestinal DiseasesIntestinal Research1598-91002017-01-0115112412910.5217/ir.2017.15.1.124ir.2017.15.1.124Metronidazole-induced encephalopathy in a patient with Crohn's diseaseJihye Kim0Jaeyoung Chun1Jae Yong Park2Seung Wook Hong3Joo Young Lee4Jin Woo Kang5Seongjun Hwang6Sang-Bae Ko7Jong Pil Im8Joo Sung Kim9Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea.Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea.Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea.Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea.Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea.Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea.Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.Department of Neurology, Seoul National University College of Medicine, Seoul, Korea.Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea.Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea.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.https://doi.org/10.5217/ir.2017.15.1.124MetronidazoleDrug side effectsMetabolic encephalopathyCrohn disease |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Jihye Kim Jaeyoung Chun Jae Yong Park Seung Wook Hong Joo Young Lee Jin Woo Kang Seongjun Hwang Sang-Bae Ko Jong Pil Im Joo Sung Kim |
spellingShingle |
Jihye Kim Jaeyoung Chun Jae Yong Park Seung Wook Hong Joo Young Lee Jin Woo Kang Seongjun Hwang Sang-Bae Ko Jong Pil Im Joo Sung Kim Metronidazole-induced encephalopathy in a patient with Crohn's disease Intestinal Research Metronidazole Drug side effects Metabolic encephalopathy Crohn disease |
author_facet |
Jihye Kim Jaeyoung Chun Jae Yong Park Seung Wook Hong Joo Young Lee Jin Woo Kang Seongjun Hwang Sang-Bae Ko Jong Pil Im Joo Sung Kim |
author_sort |
Jihye Kim |
title |
Metronidazole-induced encephalopathy in a patient with Crohn's disease |
title_short |
Metronidazole-induced encephalopathy in a patient with Crohn's disease |
title_full |
Metronidazole-induced encephalopathy in a patient with Crohn's disease |
title_fullStr |
Metronidazole-induced encephalopathy in a patient with Crohn's disease |
title_full_unstemmed |
Metronidazole-induced encephalopathy in a patient with Crohn's disease |
title_sort |
metronidazole-induced encephalopathy in a patient with crohn's disease |
publisher |
Korean Association for the Study of Intestinal Diseases |
series |
Intestinal Research |
issn |
1598-9100 |
publishDate |
2017-01-01 |
description |
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. |
topic |
Metronidazole Drug side effects Metabolic encephalopathy Crohn disease |
url |
https://doi.org/10.5217/ir.2017.15.1.124 |
work_keys_str_mv |
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