A 45 y/o male presented with complaints of headache, fever, vomiting, and neck stiffness. No similar complaints or recurrent infections in the past. He was on metronidazole tab. 400 mg for diarrhea for the last week. CSF profile showed neutrophilic pleocytosis, increased WBC and proteins, normal glucose levels; negative CSF gram stain results and culture.
After excluding infectious cause, I suspect metronidazole-induced aseptic meningitis based on a temporal relation between drug use and symptom onset. Symptoms disappeared within 48 hrs after stopping the drug. Have you observed this effect with metronidazole? Should I confirm the diagnosis by rechallenging the patient? Any long-term sequalae?