A rare case of cerebellar toxicity after prolonged use of metronidazole: a case report

Metronidazole, a commonly used antiprotozoal and antibacterial medication is usually a safe and rarely reported to cause serious side effects. Major nervous side effects are peripheral ones, while central toxicity is rare. Following the discontinuation of the medication, clinical improvement is seen in the most cases. A 62 years old female patient was presented to hospital after experiencing the symptoms of an unsteady gait, difficulty in walking, impaired coordination of arms and legs, slurring of the speech, headache, tingling and numbness of both the feet and ascending limb weakness following intake of 400 mg metronidazole TDS daily for 2 months. The motor system examination revealed reduced muscle power, and DTR (Deep tendon reflex) was found to be 2+, except ankle reflex absent, while examination of sensory system showed, decrease pain and joint vibration sense up to the neck with absent planter reflex. The axial magnetic resonance imaging study of the brain showed bilateral symmetric hyperintensity involving both dentate nuclei in FLAIR image. The patient’s clinical conditions, on the other hand was deteriorated even after the discontinuation of the medication, hence injection methylprednisolone was given as an empirical therapy and was proved to be successful, and patient was recovered completely

Clinical and endoscopic features of pill-induced esophagitis

Background: Medication can cause an injury in the esophagus by local and systemic effect, leading to esophagitis. Many such medications have been identified as a cause of pill-induced esophagitis. This study was performed to evaluate the clinical and endoscopic findings of pill-induced esophagitis.Methods: This was retrospective observational study, conducted among patients diagnosed endoscopically with pill-induced esophagitis at Ansh gastroenterology clinic, Ahmedabad, India, from April 2017 to March 2021. The data of these patients were recorded in pre-designed case record form by evaluating their past medical records.Results: Total 90 patients were diagnosed with pill-induced esophagitis. Retrosternal chest pain (68.9%), odynophagia (41.1%), dysphagia (25.6%), and epigastric pain (14.4%) were common clinical findings. The major culprit medications were antibiotics, and NSAIDs (non-steroidal anti-inflammatory drugs). Common esophageal endoscopic findings were ulcer (84.4%), erosion (17.8%), and active ulcer bleeding (12.2%). Kissing ulcers were observed in the majority (46.7%) of cases. The majority of ulcer and erosion were located in middle third of the esophagus. All the patients were recovered within 6 to 10 days after treatment with PPIs (proton pump inhibitors) and/or antacids, and withdrawal of the causative medication.Conclusions: Pill-induced esophagitis commonly manifests as retrosternal chest pain, odynophagia and dysphagia, and endoscopy reveals kissing ulcer and erosion in the majority of cases. The condition can be treated with PPIs and/or antacids, and withdrawal of the offending medication.

Levofloxacin-Induced Fatal Hypoglycaemia in a Non-Diabetic Patient: A Case Report

Levofloxacin, a broad-spectrum, third-generation fluoroquinolone antibiotic, is rarely reported to cause life-threatening adverse effects, such as severe hypoglycaemia resulting in a coma. This case concerns hypoglycaemia in an elderly, non-diabetic patient induced by levofloxacin. A 61-year-old male patient was admitted with severe hypoglycaemia. Past medical history revealed treatment with levofloxacin for pneumonia. During the hospital stay, the patient was treated with multiple doses of 25 g dextrose 50% (D50), 2 doses of 1 mg glucagon, and a continuous infusion of dextrose 10% (D10). The patient was discharged on the sixth day of admission in a stable condition with no clinical symptoms. Clinicians must be aware of this lesser-known adverse effect to ensure quick recognition and treatment with the proper adjuncts

THROMBOTIC THROMBOCYTOPENIC PURPURA AFTER VACCINATION AGAINST COVID-19 – A CASE REPORT

Thrombotic thrombocytopenic purpura (TTP) is a rare but fatal thrombotic microangiopathy. Circulating AntiADAMTS13 antibodies produced in response to various triggering events, such as vaccinations, autoimmune disorders, malignancy, and administration of several drugs lead to acquired TTP (aTTP). This case concerns a 26-year-old male with aTTP after receiving the second dose of the Covishield vaccine (Oxford-AstraZeneca COVID-19 vaccine, code-named AZD1222). He presented with bruises, petechia, fatigue, dyspnea, and arthralgia post-vaccination. Laboratory reports showed thrombocytopenia, hemolytic anemia, a significant ADAMTS13 deficiency, and a high level of autoantibody titer against ADAMTS13. We treated the patient with plasma exchange therapy and prednisolone, and after the treatment, he recovered