Peripheral sensory neuropathy due to metronidazole

Abstract

A 60-year-old male patient took metronidazole 0.6-1.0g daily by himself for one month because of his toothache and the feeling of insect creeping at anus. He developed numbness on toes after stopping metronidazole gradually. About 10 days later, he received an IV infusion of ornidazole 0.5 g, cefuroxime sodium 2.25 g, and vinpocetine 20 mg daily for 10 days because of dizziness and vomiting.The numbness extended to his haunch 5 days after IV infusion of ornidazole. Two months after stopping ornidazole, his numbness descended to knee. The results of electromyogram 10 months after appearance of numbness showed that the axial cord injury of sensory nerves in both lower limbs and right upper limb, the degree of injury in lower limbs was more severe than that in the upper limb. Sural nerve biopsy revealed that myelinated fiber density was reduced severely, thin myelinated fibers increased. There were swollen axons and myelobulbar structure, and nerve regenerative clusters. The results of sural nerve biopsy suggested axonal lesion. The results of accessory examinations eliminated the metabolism, immunity, and inflammation related peripheral neuropathy. The patient was diagnosed as peripheral sensory neuropathy due to metronidazole. He received nutritional therapy. The feeling himself to numbness showed that his symptoms was slightly improved at follow up one year later. Key words: Metronidazole; Peripheral nervous system disease