2019 Volume 31 Issue 3 Pages 211-216
A 68-year-old woman presented with proximal scleroderma, finger edema, Raynaud’s phenomenon, interstitial pneumonia, and esophageal dysmotility in 201X-16, and was subsequently diagnosed with systemic sclerosis（SSc）. She was treated with prednisolone（5mg/day）, beraprost, lansoprazole and mosapride. She had been repeatedly in and out of the hospital, and showed symptoms of intestinal pseudo-obstruction. In March 201X, she presented with diarrhea and feebleness, and was diagnosed with recurrence of intestinal pseudo-obstruction based on the basis of significant dilatation of the small intestine and colon on abdominal X-ray findings. Although the pantethine and dinoprost treatments did not improve the symptoms, the symptoms disappeared promptly after the initiation of metronidazole（1500 mg/day）in May 201X. In September 201X, she presented with dysphemia and cerebellar ataxia. T2-weighted and FLAIR magnetic resonance imaging showed high signals bilaterally in the cerebellar dentate nucleus, splenium, and brain stem. She was diagnosed with metronidazole-induced encephalopathy, and the metronidazole were terminated. On the fourth day after metronidazole cessation, the symptoms improved, and then the symptoms disappeared on the 14th day. Metronidazole-induced encephalopathy has been rarely reported in Japan. Although there have been reports of patients who used metronidazole at the total dose of 95.9 g, the patient presented here used a total dose of 126 g. Metronidazole is effective against intestinal pseudo-obstruction associated with SSc. However, this case showed that metronidazole-induced encephalopathy with SSc appeared later in comparison to what is seen in case of other diseases.
