Metronidazole induced myelitis: Case report

Introduction : Metronidazole is an antimicrobial agent commonly used in the treatment of several protozoal and anaerobic bacterial infections, bacterial vaginosis infections.Neurotoxicity is one of the more serious adverse effects of Metronidazole therapy, but it is very rare.Case presentation : A 42-year-old woman with Chief Complain paresthesia in lower limbs and headache was referred to our hospital. She was diagnosed with bacterial vaginosis 6 days ago and decided to use vaginal medications. Vaginal administration of metronidazole 500mg twice day was initiated. Five days after starting metronidazole, she complained of paresthesia and tingling in the lower limbs and headache. In physical exam: Hyposthesia was detected in the lower limbs and left plantar reflex was muted. Central nervous system disorder was suspected, and brain and panspinal MRI was performed.Thoracic Spine MRI: A T2 high lesion of the thoracic cord at T7 level involving dorsal column without significant cord swelling.Brain MRI: One tiny unidentified bright objects subcortical white matter of left frontal lobe.By clinical symptoms, past drug history and unique imaging results, the patient was diagnosed with metronidazole-induced neurotoxicity. Metronidazole was discontinued, and by considering Myelitis possibility, 1000 mg methylprednisolone was administered for 5 days. Patient had significant improvement in her symptoms over the next few weeks.Conclusion: Metronidazole should be used with some caution and with clear indications even when prescribing for short course and low doses. In conclusion, regarding to the coincidence in time and exclusion of other possible underlying conditions, the reported case was most probably referred as drug-related myelitis.