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CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2020; 78(05): 311-312
DOI: 10.1590/0004-282X20190190
Images in Neurology

Metronidazole neurotoxicity in late liver transplantation

Neurotoxidade por metronidazol em pós-operatório de transplante de fígado
Lívia Pinheiro de OLIVEIRA
1   Universidade Federal do Paraná, Hospital de Clínicas, Departamento de Neurologia, Curitiba PR, Brazil.
,
Paula Teixeira MARQUES 
1   Universidade Federal do Paraná, Hospital de Clínicas, Departamento de Neurologia, Curitiba PR, Brazil.
,
Marcos Cristhiano LANGE 
1   Universidade Federal do Paraná, Hospital de Clínicas, Departamento de Neurologia, Curitiba PR, Brazil.
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A 67-year-old female developed subacute peripheral neuropathy, nystagmus and encephalopathy. She was on continuous metronidazole use for 65 days for a liver abscess after receiving a transplantation. Diagnostic workup revealed a sensory axonal polyneuropathy in electroneuromyography. Brain magnetic resonance imaging (MRI) showed hyperintensities at the dentate nucleus and pons ([Figure 1]). Metronidazole treatment was discontinued and within the first week the patient evolved with complete improvement of encephalopathy. However, she maintained the neuropathy symptoms. A control brain MRI was normal after 30 days ([Figure 2]). Metronidazole neurotoxicity was previously reported with these same imaging findings and clinical course[1],[2],[3],[4].

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Figure 1 Brain MRI with symmetric hyperintensity on axial T2-weighted images at the dentate nucleus (A, B) and pons (B), and increased signal on axial FLAIR images (C, D).
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Figure 2 Axial FLAIR image 30 days after metronidazole interruption demonstrates complete reversal of signal changes


Publication History

Received: 21 October 2019

Accepted: 10 November 2019

Article published online:
13 June 2023

© 2020. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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