Reversible Metronidazole-induced Encephalopathy in a Patient with Acute Lymphoblastic Leukemia during Chemotherapy
10.15264/cpho.2017.24.2.153
- Author:
Hyunwoo BAE
1
;
So Mi LEE
;
Ji Yoon KIM
Author Information
1. Department of Pediatrics, Kyungpook National University School of Medicine, Daegu, Korea. phojyk@knu.ac.kr
- Publication Type:Case Report
- Keywords:
Metronidazole;
Encephalopathy;
Chemotherapy;
Leukoencephalopathy
- MeSH:
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
- From:Clinical Pediatric Hematology-Oncology
2017;24(2):153-156
- CountryRepublic of Korea
- Language:English
-
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.
