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Case Report
Sensory-motor polyneuropathy due to the use of antiparasitic drugs: A case report
1 Physician, Neurologist, Adjunct Professor of Medicine at Universidade Iguaçu, Iguaçu University - UNIG/Nova Iguaçu, RJ, Brazil
2 Medical student at Universidade Federal Fluminense - UFF/Niterói - RJ, Brazil
3 Medical student at Iguaçu University - UNIG/RJ, Nova Iguaçu - RJ, Brazil
4 Division of Neuromuscular Diseases, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil
5 Physician at the Paulista School of Medicine of the Federal University of São Paulo - UNIFESP SP, São Paulo - SP, Brazil
6 Department of Neurology of Hospital Geral de Nova Iguaçu, PhD student in Neurology at the Federal University of the State of Rio de Janeiro - UNIRIO, Adjunct Professor of Medicine at Iguaçu University - UNIG/Nova Iguaçu, RJ, Brazil
Address correspondence to:
Antônio Marcos da Silva Catharino
Rua Gavião Peixoto 70, Sala 811, CEP 24.2230-100, Icaraí, Niterói - RJ,
Brazil
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Article ID: 101402Z01MN2023
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How to cite this article
Neves MAO, Cwajgenberg I, Pereira DA, Bocca W, de Oliveira AB, da Silva Catharino AM. Sensory-motor polyneuropathy due to the use of antiparasitic drugs: A case report. Int J Case Rep Images 2023;14(2):13–16.ABSTRACT
Introduction: The term polyneuropathy refers to a generalized involvement of peripheral nerves, usually involving mainly the distal nerves and, more often, presenting with sensory, motor, and autonomic symptoms and clinical findings. Drug-induced peripheral neuropathy (DIPN) is a persistent condition, most often associated with anticonvulsants, chemotherapy, cardiovascular, psychotropic, and antimicrobial drugs, such as Metronidazole. In this article, we report the case of a patient who developed polyneuropathy secondary to the use of Metronidazole.
Case Report: D.D.S.L., a 45-year-old female, previously healthy, presented with abdominal discomfort. Entamoeba histolytica was detected after investigation, and she started a 7-day cycle of 500 mg of Metronidazole three times a day for seven days, without clinical response. A new therapeutic approach was attempted, with three cycles of 2 grams of Secnidazole single dose and Tinidazole for four weeks. However, the patient presented dysesthesia in the distal third of the thighs, followed by allodynia in the four limbs and trunk. After new abdominal discomfort, three months after the first medication cycle, another pharmacological cycle was started. Neurological examination and electroneuromyography (ENM) examination suggested axonal sensorimotor polyneuropathy in all four limbs.
Conclusion: Polyneuropathy can be caused by many factors, including some frequently prescribed drugs such as Metronidazole and other medications in the 5-nitroimidazole group. Therefore, although the relationship between these drugs and polyneuropathy is not fully elucidated, their neurotoxicity is indisputable, even in rare cases, but with significant variability in terms of the dose-dependent potential for this disease.
Keywords: Antiparasitic agents, Metronidazole, Neuropathology, Tinidazole, Toxicity
SUPPORTING INFORMATION
Author Contributions
Marco Antônio Orsini Neves - Conception of the work, Design of the work, Drafting the work, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Ilana Cwajgenberg - Conception of the work, Design of the work, Acquisition of data, Drafting the work, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Daniel Antunes Pereira - Acquisition of data, Analysis of data, Drafting the work, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Wladimir Bocca - Conception of the work, Design of the work, Analysis of data, Drafting the work, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Acary Bulle de Oliveira - Analysis of data, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Antônio Marcos da Silva Catharino - Analysis of data, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Guarantor of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2023 Marco Antônio Orsini Neves et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
