Clin Pediatr Hematol Oncol.  2017 Oct;24(2):153-156. 10.15264/cpho.2017.24.2.153.

Reversible Metronidazole-induced Encephalopathy in a Patient with Acute Lymphoblastic Leukemia during Chemotherapy

• Bae H
• Lee SM
• Kim JY

• KMID: 2396019
• DOI: http://doi.org/10.15264/cpho.2017.24.2.153

Abstract

We describe our experience regarding metronidazole-induced encephalopathy in a patient with acute lymphoblastic leukemia during chemotherapy. A 17-year-old girl was admitted to our institution with complaints of abdominal pain and mucoid stools. She was diagnosed with acute lymphoblastic leukemia and had been undergoing intensified chemotherapy protocol. During the fifth week of interim maintenance-1 therapy, she developed a fever and complained of chills. On stool examination, stool occult blood was positive and Clostridium difficile toxin A/B test was positive. She was started on metronidazole treatment for possible Clostridium difficile infection and other inflammatory gastrointestinal diseases. Ten days later, the patient complained of dizziness and nausea. A brain MRI was performed to make a differential diagnosis of any chemotherapy- induced CNS complication such as necrotizing leukoencephalopathy. The brain MRI showed features of metronidazole-induced encephalopathy. Metronidazole was discontinued and symptoms started to subside four days after. A follow-up brain MRI performed at four weeks showed that lesions of the dentate nucleus had disappeared.

Keyword

Metronidazole; Encephalopathy; Chemotherapy; Leukoencephalopathy

MeSH Terms

Abdominal Pain
Adolescent
Brain
Brain Diseases*
Cerebellar Nuclei
Chills
Clostridium difficile
Diagnosis, Differential
Dizziness
Drug Therapy*
Female
Fever
Follow-Up Studies
Gastrointestinal Diseases
Humans
Leukoencephalopathies
Magnetic Resonance Imaging
Metronidazole
Nausea
Occult Blood
Precursor Cell Lymphoblastic Leukemia-Lymphoma*
Metronidazole