Rapid Onset Peripheral Neuropathy in a Patient with Amoebic Liver Abscess on Metronidazole - A Rare Complication

Aim: We report here a case where the patient developed peripheral neuropathy during a short course of metronidazole treatment at a low cumulative dose which has been rarely reported. This case thus highlights the importance for a treating medical professional to keep in mind that peripheral neuropathy may develop in a patient on metronidazole even on a short duration of it. This peripheral neuropathy is reversible.

Presentation of Case: A 40 year old male patient with no past history of alcohol habit or diabetes was admitted with right side chest pain. Ultrasound and CECT abdomen revealed Amoebic Liver Abscess. He was treated with Metronidazole. After one week of therapy (cumulative dose -16.8 gms) he developed severe burning pain in bilateral lower limbs with Nerve Conduction Velocity (NCV) study confirming mixed neuropathy. His symptoms resolved after stopping Metronidazole.

Discussion: The exact mechanism of Metronidazole induced peripheral neuropathy is unknown. It is believed to be secondary to axonal degeneration. It binds to neuronal RNA and inhibits protein synthesis. This results in axonal degeneration.

Conclusion: Metronidazole is a widely prescribed drug for treatment of amoebic liver abscess. It can cause peripheral neuropathy in patients even on a short course of treatment. Thus it is important to detect this early and discontinue the medication to prevent development of persistent neuropathy.