Metronidazole-induced Reversible Encephalopathy in a Patient with Facioscapulohumeral Muscular Dystrophy
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Correspondence
Metronidazole-induced Reversible Encephalopathy in a Patient with Facioscapulohumeral Muscular Dystrophy A. Papathanasiou · V. Zouvelou · S. Kyriazi · M. Rentzos · I. Evdokimidis
Received: 31 May 2012 / Accepted: 28 July 2012 © Springer-Verlag 2012
Introduction Metronidazole is a synthetic nitroimidazole antibiotic, active against protozoans and Gram-positive and -negative anaerobic bacteria. Most common adverse effects include abdominal discomfort, nausea, vomiting, headache, and metallic taste. Although rare, several adverse neurologic effects such as peripheral neuropathy, ataxia, dizziness, seizures, and metronidazole-induced encephalopathy (MIE) have been reported [1]. Facioscapulohumeral muscular dystrophy (FSHD) is a dominantly inherited muscular dystrophy (incidence 1/20,000) with a high frequency of sporadic cases, that has been mapped to 4q35. The clinical spectrum of disease ranges from almost asymptomatic to wheelchair–bound patients. FSHD is characterized by asymmetrical weakness of facial, shoulder girdle, truncal and anterior tibial muscles. Extramuscular manifestations are usually confined to hearing loss and retinal telangiectasias [2]. We report a case of MIE in a patient with adult-onset FSHD. Case Presentation A 62–year–old male was admitted for evaluation of rapidly progressive cognitive decline, particularly attention deficits, A. Papathanasiou, MD () · V. Zouvelou · M. Rentzos · I. Evdokimidis Department of Neurology, Aeginition Hospital, National and Kapodistrian University of Athens, Vasilisis Sofias 72–74, 11528 Athens, Greece e-mail: [email protected] S. Kyriazi MRI Department, Evgenideion Hospital, National and Kapodistrian University of Athens, Athens, Greece
short-term memory disturbance and personality changes, during the last 3 months. Moreover, he reported slowly progressive muscle weakness of upper limbs since the age of 20. Previous medical history was unremarkable and there was no report of affected family members. At presentation, he had been self-medicating with 1,500 mg metronidazole q.d. for 6 months. In particular, the patient had been initially prescribed metronidazole by his physician for febrile gastroenteritis, but kept taking it continuously. Neurological examination revealed a Mini Mental Status Examination (MMSE) score of 16/30 (orientation to time 3/5, orientation to place 3/5, registration 2/3, attention and calculation 0/5, recall 1/3, language and complex commands 6/8, construction 1/1). In addition, asymmetrical facial weakness, weakness of neck extensors, scapula fixators and pectoralis major muscles with prominent scapular winging, horizontal clavicles and prominent anterior axillary folds were observed. The facial weakness along with scapular winging was indicative of FSHD. Needle electromyography revealed a myopathic pattern, while motor and sensory conduction studies were normal. Laboratory assays, including creatine kinase, were normal. The diagnosis of 4q35 FSHD was confirmed by detection of a 2 SD) in complex attention and exec
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