Metronidazole-Induced Neurotoxicity: A Rare Case Report

Introduction: Metronidazole, a commonly used nitroimidazole antibiotic, is associated with various side effects, including neurological complications such as toxic peripheral neuropathy, cerebellar dysfunction, and seizures. Despite its widespread use, serious neurological effects can occur, necessitating prompt diagnosis and discontinuation of treatment. Observation: We present the case of a 26-year-old patient with colonic Crohn's disease treated with metronidazole, who experienced both central and peripheral neurotoxicity after a cumulative exposure of 42 days. The patient presented with convulsive seizures and paresthesia of the lower limbs, prompting a comprehensive etiological work-up, including metabolic assessments, imaging studies, and lumbar puncture. The absence of abnormalities in diagnostic tests, coupled with symptom improvement upon discontinuation of metronidazole, led to the diagnosis of metronidazole-induced neurotoxicity. Discussion: Metronidazole-induced neurotoxicity is a known but underreported complication, affecting both the central and peripheral nervous systems. The duration of treatment before symptom onset can vary, and the association of central and peripheral symptoms is rare. Radiological findings, often observed on T2-weighted MRI, may show characteristic lesions, but their absence does not exclude the diagnosis. The pathogenesis involves metronidazole's ability to cross the blood-brain barrier, leading to the generation of superoxide radicals and axonal swelling. Prompt recognition and discontinuation of metronidazole are crucial for potential symptom resolution. Conclusion: This case underscores the importance of considering metronidazole-induced neurotoxicity in patients presenting with neurological symptoms during or after metronidazole treatment. A high clinical suspicion, coupled with a detailed evaluation and, if needed, discontinuation of metronidazole, is vital for timely diagnosis and management. Recognition of this ........