Key result
Metronidazole exposure was associated with a relatively mild sensory neuropathy with predominant involvement of small fibers and milder, mostly subclinical involvement of large fibers in four patients.
Why the study?
What are the characteristics of sensory neuropathy associated with metronidazole exposure?
Case Report (n=4)
What are the characteristics of sensory neuropathy associated with metronidazole exposure?
Paresthesias associated with metronidazole exposure may result from a relatively mild sensory neuropathy predominantly involving small fibers.
Metronidazole may cause sensory neuropathy even topically; case series leave incidence and causality open for prospective study.
OBJECTIVE: To better characterize sensory neuropathy associated with metronidazole. METHODS: We report four patients who developed dysesthesias after metronidazole treatment. One received topical metronidazole only. All four underwent electrodiagnostic studies, including nerve conduction studies (NCS), quantitative sensory testing (QST), and quantitative sudomotor axon reflex testing (QSART). One underwent nerve biopsy. RESULTS: NCS were normal in all patients. QST showed impaired vibration thresholds in three patients. Three of four patients had abnormal tests of small fiber function. Cooling thresholds were abnormal in one; QSART was abnormal in one and borderline in another. The nerve biopsy specimen showed mild loss of small myelinated axons. CONCLUSIONS: This study shows that paresthesias associated with metronidazole exposure may be the result of a relatively mild sensory neuropathy with predominant involvement of small fibers and milder, mostly subclinical involvement of large fibers.
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Živković et al. (2001) conducted a case report in Sensory neuropathy (n=4). Metronidazole was evaluated on Electrodiagnostic study findings (NCS, QST, QSART) and nerve biopsy. Metronidazole exposure was associated with a relatively mild sensory neuropathy with predominant involvement of small fibers and milder, mostly subclinical involvement of large fibers in four patients.
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