A 53-year-old male patient developed insidious onset of length-dependent painful neuropathy on a background of encephalopathy during prolonged treatment with metronidazole for a cumulative dose of 146 g in 88 days. The reversible encephalopathy was documented with gradual resolution of hyperintense lesions in bilateral cerebellum and brainstem on brain MRI together with the improvement in symptoms of ataxia and dysarthria. The concomitant impairment of small-diameter sensory nerves posed a diagnostic challenge. The authors took advantage of serial skin biopsies to demonstrate reversible metronidazole-induced small-fibre sensory neuropathy, that is, skin denervation after metronidazole and corresponding skin reinnervation with the disappearance of sensory symptoms.
- Skin innervation
- small-fibre neuropathy
- brain abscess
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Funding This work was supported by a grant (NSC97-2320-B-002-042-MY3) from the National Science Council, Taiwan and one (NHRI-EX98-9736NI) from the National Health Research Institute, Taiwan.
Competing interests None.
Patient consent Obtained.
Ethics approval Ethics approval was provided by the Ethics Committee of National Taiwan University Hospital, Taipei, Taiwan.
Provenance and peer review Not commissioned; externally peer reviewed.