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Neurology
Metronidazole-induced encephalopathy and polyneuropathy
  1. Partha Sahu1,
  2. Nivedita Sharma2,
  3. Prasan Kumar Panda1 and
  4. Jaideep Pilania1
  1. 1General Medicine (ID Division), All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
  2. 2Radiodiagnosis, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
  1. Correspondence to Dr Prasan Kumar Panda; motherprasanna@rediffmail.com

Abstract

Though effective, metronidazole poses multiple side effects, especially with prolonged therapy or high dosage. Among these are metronidazole-induced peripheral neuropathy and encephalopathy, which are severely debilitating. We describe a middle-aged man with a liver abscess who was treated with metronidazole 2.4 g/day for nearly 2 months, and who went on to develop dysarthria, ataxic gait and sensory loss, including numbness and burning paraesthesia in his limbs. Neurological assessment comprised nerve conduction studies (NCS) and magnetic resonance imaging (MRI). NCS indicated axonal neuropathy, and MRI revealed T2/FLAIR hyperintensities in the dentate nuclei and corpus callosum, which are indicative of toxic encephalopathy. Symptoms improved considerably after metronidazole was stopped. This case documents the possibility of metronidazole-induced severe neurological sequelae, such as peripheral neuropathy and encephalopathy, especially with high doses (140 gm) or prolonged therapy. Clinicians must remain vigilant for evidence of neurotoxicity in metronidazole-treated patients, especially those on prolonged or high-dose therapy.

  • Drugs and medicines
  • Infections
  • Neurology (drugs and medicines)

https://doi.org/10.1136/bcr-2025-264913

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    Footnotes

    • Contributors The following authors were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms, and critical revision for important intellectual content: PS, NS, PKP and JP. The following authors gave final approval of the manuscript: PS, NS, PKP and JP. The guarantor is PKP.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.