Metronidazole-Induced Encephalopathy in a 16-Year-Old Girl with Crohn’s Disease: Case Report and Review of the Pediatric Literature
Abstract
:1. Introduction
2. Case Presentation
3. Discussion
4. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Author, Year, Country | Age (Years), Sex | Indication | Cumulative Dose of Metronidazole | Days to First Symptoms; Total Duration of Treatment | Symptoms and Clinical Findings | MRI Findings | Follow Up MRI | Outcome |
---|---|---|---|---|---|---|---|---|
Bailes, 1983, USA [1] | 12, M | Perforated appendicitis | 4 g | 4; 4 | Altered mental status; seizures | N/A | N/A | Resolution |
Bates, 2015, USA [2] | 36-day-old, M | Mother’s vaginosis (utero exposure) | N/A | N/A; N/A | Hypothermia; bradycardia; failure to thrive; decreased tone and strength | T2: symmetrical hyperintensity in the dentate nuclei | Not done | Resolution |
Cecil, 2002, USA [3] | 17, M | Crohn’s disease | N/A | N/A; N/A | Gait instability; Polyneuropathy; visual disturbance; tremor | T2: Symmetrical hyperintensity in the substantia nigra, red nucleus, globus pallidus, the putamen, caudate body, caudate heads and medial thalami | Near complete resolution | Near complete resolution |
Chang, 2021, USA [4] | 14, M | Clostridium difficile enterocolitis | N/A | N/A; N/A | Altered mental status; stiffening of 4 extremities; visual disturbance; slurred speech; gait instability | T2: symmetrical hyperintensity with corresponding diffusion restriction on DWI in posterior frontal, parietal, and occipital periventricular white matter and splenium of the corpus callosum | Near complete resolution | Near complete resolution |
Chatzkel, 2010, USA [5] | 15, F | Crohn’s disease | N/A | 7; N/A | Ataxia; dysmetria | T2: Symmetrical hyperintensity in the dentate nuclei | Resolution | N/A |
Gaye, USA, 2007 [6] | Teenager, M | appendectomy | N/A | N/A; N/A | Unresponsiveness; respiratory distress; decerebrate posturing | Left parietal flair signal | N/A | Resolution |
Kafadar, 2013, Turkey [7] | 3, M | amoebiasis diarrhea | N/A | 14; N/A | Loss of vision; ataxia, dizziness | Normal | N/A | Resolution |
Omrani, Iran, 2020 [8] | 11, M | Febrile bloody diarrhea | 12 g | N/A; N/A | Tinnitus; hearing loss; aggressive behavior; generalized dystonia; generalized tonic-clonic seizure; decreased level of consciousness. | T2: Symmetrical hyperintensity in dentate nuclei, substantia nigra, globus pallidi, splenium of the corpus callosum, and centrum semiovale | Improvement | Partial improvement |
Patel, USA, 2020 [9] | 8, M | Prophylaxis after small bowel transplantation | 1378.8 g | Three years; three years | Ataxia | T2: Symmetrical hyperintensity in the dentate nuclei, inferior olivary nuclei, putamen, and corpus callosum | Resolution | Resolution |
Starrs, 2021, USA [10] | 12, M | Clostridium deficile infection | N/A | 75; 75 | Vertigo; nausea; vomiting; ataxia; gait instability | T2: Symmetrical hyperintensity in the dentate nuclei | N/A | Resolution |
Sudan, 2016, India [11] | 14, M | Acute abdominal pain | N/A | 3; 5 | Dysarthria; altered mental status; seizures. | T2: symmetrical hyperintensity in the optic tracts, dorsal midbrain, inferior olivary nuclei, peri-aqueductal white matter, superior and inferior colliculi, superior cerebellar peduncle, dentate nuclei, medulla oblongata, and cervical spinal cord segment extending from the cervicomedullary junction to C6-C7 level DWI: restricted diffusion in the splenium of the corpus callosum | N/A | Resolution |
Sun, 2019, USA [12] | 11, M | Fusobacterium menigitis | N/A | 3 months; N/A | Vomiting; dizziness; vertigo; gait instability; bilateral lower extremity paresthesia | T2: Symmetrical hyperintensity in the dentate nuclei, dorsal pons, and medulla. DWI: no restricted diffusion | Resolution | Resolution |
Yazdani, 2019, USA [13] | 17, M | Chronic diarrhea | N/A | N/A | Gait instability; abnormal unilateral lean | T2: Symmetrical signal hyperintensity in dorsal pons, dentate nuclei, dorsal medulla | Improvement | Resolution |
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Rybak, K.; Warchoł, A.; Drobczyński, Ł.; Banaszkiewicz, A. Metronidazole-Induced Encephalopathy in a 16-Year-Old Girl with Crohn’s Disease: Case Report and Review of the Pediatric Literature. Children 2022, 9, 1408. https://doi.org/10.3390/children9091408
Rybak K, Warchoł A, Drobczyński Ł, Banaszkiewicz A. Metronidazole-Induced Encephalopathy in a 16-Year-Old Girl with Crohn’s Disease: Case Report and Review of the Pediatric Literature. Children. 2022; 9(9):1408. https://doi.org/10.3390/children9091408
Chicago/Turabian StyleRybak, Karolina, Aleksandra Warchoł, Łukasz Drobczyński, and Aleksandra Banaszkiewicz. 2022. "Metronidazole-Induced Encephalopathy in a 16-Year-Old Girl with Crohn’s Disease: Case Report and Review of the Pediatric Literature" Children 9, no. 9: 1408. https://doi.org/10.3390/children9091408