{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T16:28:42Z","timestamp":1777307322317,"version":"3.51.4"},"reference-count":16,"publisher":"BMJ","issue":"4","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2025,4,8]]},"published-print":{"date-parts":[[2025,4]]},"abstract":"<jats:p>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\u2009g\/day for nearly 2\u2009months, 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\u2009gm) or prolonged therapy. Clinicians must remain vigilant for evidence of neurotoxicity in metronidazole-treated patients, especially those on prolonged or high-dose therapy.<\/jats:p>","DOI":"10.1136\/bcr-2025-264913","type":"journal-article","created":{"date-parts":[[2025,4,22]],"date-time":"2025-04-22T15:20:24Z","timestamp":1745335224000},"page":"e264913","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Metronidazole-induced encephalopathy and polyneuropathy"],"prefix":"10.1136","volume":"18","author":[{"given":"Partha","family":"Sahu","sequence":"first","affiliation":[{"name":"General Medicine (ID Division), All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nivedita","family":"Sharma","sequence":"additional","affiliation":[{"name":"Radiodiagnosis, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3008-7245","authenticated-orcid":false,"given":"Prasan Kumar","family":"Panda","sequence":"additional","affiliation":[{"name":"General Medicine (ID Division), All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jaideep","family":"Pilania","sequence":"additional","affiliation":[{"name":"General Medicine (ID Division), All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,4,22]]},"reference":[{"key":"2025082722390577000_18.4.e264913.1","first-page":"261","article-title":"Adverse effects of metronidazole: A review","volume":"45","author":"Miller","year":"2001","journal-title":"Antimicrob Agents Chemother"},{"key":"2025082722390577000_18.4.e264913.2","first-page":"1340","article-title":"Clinical review of gastrointestinal and neurological effects of metronidazole","volume":"98","author":"Laine","year":"2003","journal-title":"Am J Gastroenterol"},{"key":"2025082722390577000_18.4.e264913.3","first-page":"497","article-title":"Neurological complications of metronidazole therapy","volume":"79","author":"Masood","year":"2012","journal-title":"Neurology (ECronicon)"},{"key":"2025082722390577000_18.4.e264913.4","first-page":"98","article-title":"Treatment involves cessation of offending agent; improvement observed","volume":"57","author":"Wu","year":"2016","journal-title":"Neurotoxicology"},{"key":"2025082722390577000_18.4.e264913.5","first-page":"113","article-title":"Metronidazole-induced peripheral neuropathy: A systematic review","volume":"51","author":"Nakajima","year":"2018","journal-title":"J Clin Neurosci"},{"key":"2025082722390577000_18.4.e264913.6","first-page":"144","article-title":"Consider MIE in reversible splenial lesion syndrome with metronidazole history","volume":"43","author":"Peng","year":"2020","journal-title":"Clin Neuropharmacol"},{"key":"2025082722390577000_18.4.e264913.7","first-page":"543","article-title":"Hepatic\/renal dysfunction increases MIE risk","volume":"75","author":"Chaudhari","year":"2022","journal-title":"Hepatology"},{"key":"2025082722390577000_18.4.e264913.8","first-page":"417","article-title":"High suspicion needed; MRI crucial for diagnosis","volume":"30","author":"Damodaran","year":"2022","journal-title":"Infect Dis Clin Pract"},{"key":"2025082722390577000_18.4.e264913.9","unstructured":"Sharma R , Patel V , Verma N . 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