Neurological Complications of Prolonged Metronidazole Therapy: A Case of Reversible Encephalopathy.

INTRODUCTION: Metronidazole-induced encephalopathy (MIE) is a rare but potentially reversible adverse effect associated with prolonged metronidazole use. CASE PRESENTATION: We report a case of a 65-year-old male who developed progressive dizziness, ataxia, and confusion after 43 days of metronidazole therapy initiated for a ruptured liver abscess. MRI of the brain revealed bilateral symmetrical T2/FLAIR hyperintensities involving the dentate nuclei and dorsal brainstem, consistent with MIE. Cerebrospinal fluid analysis was inconclusive for infection. Prompt discontinuation of metronidazole led to rapid clinical improvement, with complete resolution of symptoms within 3 to 4 days. No corticosteroids were used. CONCLUSION: This case emphasizes the importance of considering MIE in patients on long-term metronidazole who present with neurological symptoms and highlights the role of MRI in diagnosis. Early recognition and withdrawal of the offending drug are critical to prevent permanent neurological damage.