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Painful neuropathy due to skin denervation after metronidazole-induced neurotoxicity
  1. Chun-Hsiang Tan1,
  2. Ya-Fang Chen2,
  3. Chih-Chuan Chen1,
  4. Chi-Chao Chao1,
  5. Horng-Huei Liou1,3,
  6. Sung-Tsang Hsieh1,4
  1. 1Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
  2. 2Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan
  3. 3Department of Pharmacology, National Taiwan University College of Medicine, Taipei, Taiwan
  4. 4Department of Anatomy and Cell Biology, National Taiwan University College of Medicine, Taipei, Taiwan
  1. Correspondence to Dr Sung-Tsang Hsieh, Department of Neurology, National Taiwan University Hospital, 7 Chung-Shan S Road, Taipei 10002, Taiwan; shsieh{at}


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
  • neurotoxicity
  • metronidazole
  • brain abscess
  • neuropathy

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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.