Metronidazole
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Peripheral nerve disorders: case report A 15-year-old girl developed autonomic peripheral nerve disorders after receiving metronidazole for a urinary tract infection. The girl received metronidazole [dosage not stated]. It was stopped after a few days because of diarrhoea. After 2 weeks, she developed acute pain in her hands and her feet that was ‘like walking over hot coals.’ Her symptoms were initially intermittent, but became constant over a period of days. After 1 week, the sensation in her hands resolved. The pain in her feet increased to involve the dorsum of both feet. She found that submerging her feet in ice water provided some pain relief. The girl was diagnosed with an arthrus reaction and received prednisone. About 2 weeks after her symptoms started, she began receiving gabapentin. Her pain did not improve and she was referred for treatment. An examination revealed pitting oedema on her feet and ankles, with erythema of her distal legs to her midcalf area. She had a slightly reduced vibratory sense at her toes, and temperature perception was decreased from her toes to the upper third of her shin, bilaterally. She was hyperaesthetic to pressure and touch below her knees, and could not walk. When her feet were removed from the ice water, they became warm and red. A lumbar puncture showed a protein level of 100 mg/dL and a glucose level of 57 mg/dL. A technetium 99mm methylene diphosphonate bone scan of her feet suggested reflex sympathetic dystrophy. She had decreased sensory nerve amplitude potentials, compound muscle action potentials and peroneal conduction velocity. Sympathetic skin response testing with loud sounds and coughing did not elicit any reproducible responses in her right hand and foot. She was diagnosed with a severe sensorimotor and autonomic peripheral nerve disorder. It was suspected to be a toxic reaction to metronidazole. She received gabapentin, carbamazepine and oxycodone/paracetamol, and her prednisone dosage was tapered. One week after admission, she was discharged. Her pain had markedly improved and she could walk short distances. After 6 months, she was asymptomatic and not receiving any medications. Nerve conduction and skin potentials were normal. Author comment: "[T]he time course of her illness suggests that a toxic reaction to metronidazole caused her acute neuropathy." Hobson-Webb LD, et al. Metronidazole: newly recognized cause of autonomic neuropathy. Journal of Child Neurology 21: 429-431, No. 5, May 2006 801046549 USA
0114-9954/10/1122-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Reactions 7 Oct 2006 No. 1122
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