A case of metronidazole-induced encephalopathy involving a patient on hemodialysis

An 80-year-old woman undergoing maintenance hemodialysis for CKD was hospitalized with aspiration pneumonia. Sulbactam/ampicillin (SBT/ABPC) was initiated, but she experienced diarrhea on day 5 and was diagnosed with Clostridioides difficile (CD) infection. She was then placed on metronidazole (MNZ) but developed impaired consciousness on day 10. MRI of the head showed high signal intensity areas in the white matter within the cerebellar dentate nuclei and splenium of the corpus callosum, leading to a diagnosis of metronidazole-induced encephalopathy (MIE). MNZ was switched to oral vancomycin, and consciousness improved on day 18. Hemodialysis patients can develop MIE even with short-term, low-dose MNZ.