{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T05:16:15Z","timestamp":1780636575253,"version":"3.54.1"},"reference-count":14,"publisher":"SAGE Publications","issue":"11","license":[{"start":{"date-parts":[[2000,11,1]],"date-time":"2000-11-01T00:00:00Z","timestamp":973036800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Ann Pharmacother"],"published-print":{"date-parts":[[2000,11]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE:<\/jats:title>\n                    <jats:p>To report a case of changes documented by magnetic resonance imaging (MRI) of the head probably due to accumulation of metronidazole in a patient with liver dysfunction.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CASE SUMMARY:<\/jats:title>\n                    <jats:p>A 34-year-old Hispanic man with cirrhosis and hepatitis C being treated with metronidazole for Bacteroides fragilis meningitis and bacteremia developed ataxia, disorientation, and peripheral neuropathy. An MRI at the time meningitis was diagnosed was negative. After the patient received &gt;60 g of metronidazole, an MRI revealed increased signal intensity below, behind, and lateral to the fourth ventricle. Concomitant metronidazole serum concentration was toxic at 35.1 \u03bcg\/mL.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>DISCUSSION:<\/jats:title>\n                    <jats:p>This is the second reported case of metronidazole-induced MRI changes. Metronidazole is known to accumulate in patients with liver dysfunction and can cause peripheral neuropathy and central nervous system (CNS) dysfunction; these effects may take up to two years to completely resolve.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>Metronidazole dosages should be reduced in patients with liver dysfunction to prevent the accumulation of metronidazole, which can lead to CNS dysfunction and peripheral neuropathy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1345\/aph.10028","type":"journal-article","created":{"date-parts":[[2003,6,3]],"date-time":"2003-06-03T16:49:01Z","timestamp":1054658941000},"page":"1273-1275","source":"Crossref","is-referenced-by-count":40,"title":["Toxic Metronidazole-Induced MRI Changes"],"prefix":"10.1177","volume":"34","author":[{"given":"Cheryl K","family":"Horlen","sequence":"first","affiliation":[{"name":"Cheryl K Horlen PharmD, Assistant Clinical Instructor, Pharmacy Practice Resident, School of Pharmacy, Texas Tech University Health Sciences Center, Lubbock, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles F","family":"Seifert","sequence":"additional","affiliation":[{"name":"Charles F Seifert PharmD FCCP BCPS, Professor of Pharmacy Practice, Regional Dean for Lubbock Programs, School of Pharmacy, Texas Tech University Health Sciences Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cathy S","family":"Malouf","sequence":"additional","affiliation":[{"name":"Cathy S Malouf MD, Assistant Professor of Clinical Internal Medicine, School of Medicine, Texas Tech University Health Sciences Center"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2000,11,1]]},"reference":[{"key":"bibr-bibr1-aph.10028","doi-asserted-by":"publisher","DOI":"10.2165\/00003088-198308010-00003"},{"key":"bibr-bibr2-aph.10028","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.45.3.588"},{"key":"bibr-bibr3-aph.10028","doi-asserted-by":"publisher","DOI":"10.1038\/clpt.1981.154"},{"key":"bibr-bibr4-aph.10028","doi-asserted-by":"publisher","DOI":"10.1345\/aph.17241"},{"key":"bibr-bibr5-aph.10028","doi-asserted-by":"publisher","DOI":"10.1177\/106002809402800419"},{"key":"bibr-bibr6-aph.10028","doi-asserted-by":"publisher","DOI":"10.1177\/106002809002400103"},{"key":"bibr-bibr7-aph.10028","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-93-1-59"},{"key":"bibr-bibr8-aph.10028","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.2.6087.610"},{"key":"bibr-bibr9-aph.10028","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-88-3-361"},{"key":"bibr-bibr10-aph.10028","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9378(83)91214-0"},{"key":"bibr-bibr11-aph.10028","doi-asserted-by":"publisher","DOI":"10.1093\/clinids\/19.2.346"},{"key":"bibr-bibr12-aph.10028","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.287.6408.1845"},{"key":"bibr-bibr13-aph.10028","doi-asserted-by":"publisher","DOI":"10.1002\/hep.1840040427"},{"key":"bibr-bibr14-aph.10028","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.31.11.1662"}],"container-title":["Annals of Pharmacotherapy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1345\/aph.10028","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1345\/aph.10028","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T11:02:41Z","timestamp":1777374161000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1345\/aph.10028"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2000,11]]},"references-count":14,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2000,11]]}},"alternative-id":["10.1345\/aph.10028"],"URL":"https:\/\/doi.org\/10.1345\/aph.10028","relation":{},"ISSN":["1060-0280","1542-6270"],"issn-type":[{"value":"1060-0280","type":"print"},{"value":"1542-6270","type":"electronic"}],"subject":[],"published":{"date-parts":[[2000,11]]}}}