Metronidazole (MTZ) is an antibiotic from nitroimidazole group, commonly used for various medical and surgical indications especially anaerobic bacterial infection. Though usually safe, it can result in serious toxicity with prolonged use. It can affect both central and peripheral nervous system. Neurotoxicity presents as features of encephalopathy, cerebellar ataxia, dysarthria, and symmetrical sensory-motor polyneuropathy. Here, we are presenting our patient with liver abscess who received MTZ for 6 weeks and developed neurological side effects with cerebellar ataxia and dysarthria accompanied by MRI features—hyperintense signals in dentate nucleus consistent with toxicity and also features of symmetrical sensory-motor polyneuropathy. Cerebellar symptoms reversed with stopping the medication—however, his peripheral neuropathy had a static course with minimal recovery.
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