甲硝唑致感觉性周围神经病

Peripheral sensory neuropathy due to metronidazole

1例60岁男性患者因牙痛及肛门虫爬感自行服用甲硝唑，每日3～5片（0.6～1.0 g），连续服用1个月。停用甲硝唑后双脚趾逐渐出现麻木感，10余天后因眩晕、恶心呕吐连续10 d静脉滴注奥硝唑（0.5 g/d）、头孢呋辛钠（2.25 g/d）和长春西汀（20 mg/d），用药5 d时麻木感上升至腰部。停用奥硝唑后2个月内麻木感逐渐下降至双膝水平。出现麻木感10个月后肌电图检查提示双下肢和右上肢感觉神经轴索损害，下肢重于上肢。腓肠神经活体组织检查显示神经束内有髓神经纤维密度重度降低，薄髓纤维增多，可见轴索肿胀变性的髓球样结构和神经再生形成的再生簇结构，提示轴索病变。辅助检查排除了代谢性、免疫相关性、炎症相关性周围神经病，考虑为甲硝唑所致感觉性周围神经病，给予营养神经治疗。1年后随访，患者自觉下肢麻木感稍减轻。

A 60-year-old male patient took metronidazole 0.6-1.0g daily by himself for one month because of his toothache and the feeling of insect creeping at anus. He developed numbness on toes after stopping metronidazole gradually. About 10 days later, he received an IV infusion of ornidazole 0.5 g, cefuroxime sodium 2.25 g, and vinpocetine 20 mg daily for 10 days because of dizziness and vomiting.The numbness extended to his haunch 5 days after IV infusion of ornidazole. Two months after stopping ornidazole, his numbness descended to knee. The results of electromyogram 10 months after appearance of numbness showed that the axial cord injury of sensory nerves in both lower limbs and right upper limb, the degree of injury in lower limbs was more severe than that in the upper limb. Sural nerve biopsy revealed that myelinated fiber density was reduced severely, thin myelinated fibers increased. There were swollen axons and myelobulbar structure, and nerve regenerative clusters. The results of sural nerve biopsy suggested axonal lesion. The results of accessory examinations eliminated the metabolism, immunity, and inflammation related peripheral neuropathy. The patient was diagnosed as peripheral sensory neuropathy due to metronidazole. He received nutritional therapy. The feeling himself to numbness showed that his symptoms was slightly improved at follow up one year later.