Metronidazole
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Encephalopathy: case report A 70-year-old woman developed encephalopathy during treatment with metronidazole for recurrent hepatic cyst infection. The woman, who had recurrent hepatic cyst infections, started receiving oral metronidazole 500 mg/day three times daily, gentamicin and levofloxacin. After 65 days of therapy, she was hospitalised with vomiting, dizziness and dysarthria. On admission, her consciousness level was lucid along with dysarthria. Manual muscle testing revealed a score of 4/5 for all four limbs. She also had weakness in the extremities associated with cerebellar ataxia and unable to walk without support. A fluid-attenuated MRI scan showed high signal intensity in the cerebellar dentate nuclei and splenium of the corpus callosum. Based on these finding, she was diagnosed with metronidazole-induced encephalopathy. Metronidazole was discontinued, and the woman underwent hemodialysis. Twenty hours after the discontinuation, serum concentration of metronidazole was 16.94 µg/mL. On nine day of admission, follow-up MRI scan showed disappearance of high‐intensity areas in the cerebellar dentate nuclei and splenium of the corpus callosum. Serum concentration of metronidazole was also improved. On 14 day of admission, she was able to walk without support. On 28 day of admission, she was discharged. Mimura Y, et al. The pharmacokinetics of oral metronidazole in patients with metronidazole-induced encephalopathy undergoing maintenance hemodialysis. Hemodialysis 803497880 International : no pagination, Jan 2020. Available from: URL: http://doi.org/10.1111/hdi.12857
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Reactions 22 Aug 2020 No. 1818
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