Purpose. Metronidazole-induced encephalopathy (MIE) has been rarely reported. We report a case in a patient with end-stage liver disease (ESLD). Summary. A 63-year-old male with ESLD secondary to hepatitis C virus presented with progressively worsening fatigue, slurred speech, aphasia, vomiting, and left-sided facial droop after completing a 2-week course of metronidazole for recurrent Clostridium difficile-associated diarrhea. He completed a previous course of metronidazole 3 weeks prior to presentation. He is on the liver transplant waiting list and has known hepatic encephalopathy. MRI revealed hyperintense T2 signals involving the bilateral dentate nuclei, inferior colliculi and splenium of the corpus callosum, and increased diffusion restriction at the splenium of the corpus callosum. His neurological function improved over the next several days. He underwent liver transplantation 6 days after admission. A follow-up MRI 6 weeks after presentation revealed resolution of abnormalities; however, paresthesias persisted 6 months after MIE diagnosis. Conclusion. An ESLD patient with hepatic encephalopathy developed MIE after a relatively short course of metronidazole. Metronidazole has been shown to accumulate in patients with ESLD. Increased awareness for neurotoxicity when using metronidazole in ESLD patients is warranted, especially in those with potentially confounding hepatic encephalopathy.

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with 294 treated by GI and 95 treated by ID. RESULTS: The protocol viral clearance responses were similar for hepatitis C virus infection (HCV) patients treated in GI (93%) and ID (94%) as well as for HIV co-infected patients treated in ID (100%). The responses were similar for naïve (92%) and experienced (95%) and for both AA (93%) and non-AA (96%). Significant numbers of patients did not complete therapy (8%) or did not show up for their SVR visit (13%), thus lowering the intent to treat response compared to the protocol adherence response (97% vs 79%). The primary factor for not achieving an SVR was cirrhosis (99% vs 92%). CONCLUSIONS: ID treated significant numbers of both HIV and non-HIV HCV patients and response to treatment with Harvoni was similar to the SVR ratein the GI clinics. Our data also reflects the real-world results of Harvoni treatment where, intent to treat and per protocolare significantly different. We conclude from our study that treatment of hepatitis C with Harvoni has a high SVR without regard to physician specialty, race, HIV co-infection or previous treatment status.

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