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Metronidazole-induced Reversible Encephalopathy in a Patient with Facioscapulohumeral Muscular Dystrophy

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Abstract

Introduction

Metronidazole is an antibiotic with common adverse effects such as abdominal discomfort, nausea, vomiting, headache, and metallic taste. Rare cases of peripheral neuropathy, ataxia, dizziness, seizures and metronidazole-induced encephalopathy (MIE) have been reported. On the other hand, facioscapulohumeral muscular dystrophy (FSHD) is one of the most common muscular dystrophies that is typically not affecting central nervous system (CNS).

Case presentation

A 62–year–old male presented with rapidly progressive cognitive decline and slowly progressive muscle weakness of upper limbs. He was self-medicating with metronidazole due to gut infection for 6 months. Neurological examination revealed Mini Mental Status Examination (MMSE) score of 16/30, asymmetrical facial weakness and scapular winging. Diagnosis of FSHD was confirmed on Southern blot. MRI revealed T2 hyperintensities in the splenium of corpus callosum, red and dentate nuclei. Metronidazole was discontinued and after 1 year the patient had MMSE 30/30, while MRI lesions had been resolved.

Discussion

Rare cases of CNS involvement with mental retardation and seizures have been reported in infantile FSHD. In addition, typical MRI lesions in MIE involve the cerebellar dentate nuclei, midbrain and splenium. We report a case of metronidazole-induced encephalopathy in an adult-onset FSHD.

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Authors and Affiliations

  1. Department of Neurology, Aeginition Hospital, National and Kapodistrian University of Athens, Vasilisis Sofias 72–74, 11528, Athens, Greece

    Athanasios Papathanasiou MD, Vasiliki Zouvelou, Michael Rentzos & Ioannis Evdokimidis

  2. MRI Department, Evgenideion Hospital, National and Kapodistrian University of Athens, Athens, Greece

    Stavroula Kyriazi

Authors
  1. Athanasios Papathanasiou MD
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  2. Vasiliki Zouvelou
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  3. Stavroula Kyriazi
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  4. Michael Rentzos
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  5. Ioannis Evdokimidis
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Correspondence to Athanasios Papathanasiou MD.

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Papathanasiou, A., Zouvelou, V., Kyriazi, S. et al. Metronidazole-induced Reversible Encephalopathy in a Patient with Facioscapulohumeral Muscular Dystrophy. Clin Neuroradiol 23, 217–219 (2013). https://doi.org/10.1007/s00062-012-0169-7

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  • DOI: https://doi.org/10.1007/s00062-012-0169-7

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