Metronidazole
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Cytotoxic lesions with oedema of corpus callosum: case report A 57-year-old man developed cytotoxic lesions with oedema of corpus callosum following treatment with metronidazole for diarrhoea attacks. The man presented for vomiting, acute speech disturbance and ataxia. He had history of generalised tonic-clonic seizure evolved into status epilepticus shortly after admission. He was started on noninvasive mechanical ventilation. After 1 week of discharge from the ICU, he became disorientated and uncooperative. He could only follow a few simple commands and repeat some single words. He was recently diagnosed with rectal adenocarcinoma and underwent colorectal surgery. After the surgery, he had lost hearing in the right ear (i.e. two weeks prior the acute neurological presentation). An brain MRI was performed to investigate acute hearing loss, but it was unremarkable. Following colorectal surgery, he had been treated with metronidazole 1000 mg/day (total dose of 60g over two months) for diarrhoea attacks [route not stated]. Brain MRI showed a lesion involving the whole splenium of the corpus callosum and the adjacent deep cerebral white matter on the left hemisphere. The lesion was slightly hyperintense on FLAIR sequences with a prominent diffusion restriction and low signal on the ADC map, suggesting cytotoxic oedema [duration of treatment to reaction onset not stated; not all outcomes stated]. A bilateral hyperintense signal abnormalities were noted on the dentate nuclei. EEG showed diffuse slow waves on baseline. Based on the finding, metronidazole induced cytotoxic lesions with oedema of corpus callosum was considered. On week two of the hospitalisation, splenial and white matter lesions resolved. Following six months, his speech was agrammatical and nonfluent. Also, the speech consisted of scarce words and perseverations. For daily living activities, he was dependent on others. He was unable to perform complex tasks. Neuropsychological test exhibited impairment in all cognitive domains except the ventral occipito-temporal pathway. A repeat brain MRI exhibited indistinct hyperintensities on FLAIR sequences in comparison to the initial MRI. Ulukan C, et al. Metronidazole-induced cytotoxic edema of corpus callosum: a case report. Acta Neurologica Belgica 120: 1221-1223, No. 5, Oct 2020. Available from: URL: 803507735 http://doi.org/10.1007/s13760-020-01291-9
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Reactions 17 Oct 2020 No. 1826
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