간경화 환자에서 조증으로 발현한 메트로니다졸 뇌병증 = Secondary Mania as an Initial Manifestation of Metronidazole-Induced Encephalopathy in a Patient with Liver Cirrhosis

다국어 초록 (Multilingual Abstract)

Although mania is commonly associated with bipolar disorder, it can have many etiologies. Secondary mania results from pharmacological, metabolic, or neurologic causes. Mania as adverse effects of antibiotics such as metronidazole is infrequent. We report a 51-year-old man with liver cirrhosis but no past history of psychiatric illness, who developed mania after receiving metronidazole. Brain magnetic resonance imaging (MRI) showed characteristic lesions which indicated metronidazole-induced encephalopathy. After stopping metronidazole, his manic symptom disappeared. Neuroimaging examination suggests that our patient’s manic symptom was ascribable to damage to the rostral brainstem monoaminergic nuclei and its projections to the frontal-subcortical circuit components.

참고문헌 (Reference)

1 정희정, "이차성 조증과 전두피질하회로" 대한노인정신의학회 17 (17): 56-60, 2013

2 Belli H, "Solitary lesion in pontomesencephalic area related secondary mania: a case report" 24 : 223-225, 2012

3 Kim SM, "Serially changing metronidazole-induced encephalopathy" 38 : 921-924, 2011

4 Ku BD, "Secondary mania in a patient with delayed anoxic encephalopathy after carbon monoxide intoxication" 13 : 860-862, 2006

5 Higashi M, "Metronidazoleinduced encephalopathy" 52 : 843-844, 2013

6 정형철, "Metronidazole-induced encephalopathy in a patient with liver cirrhosis" 대한간학회 17 (17): 157-160, 2011

7 권겸일, "Metronidazole 중독증: 임상-신경영상 소견의 불일치를 보인 2예" 대한신경과학회 24 (24): 581-584, 2006

8 Mario F. Mendez, "Mania in Neurologic Disorders" 2 : 440-445, 2000

9 Kim E, "MR imaging of metronidazole-induced encephalopathy: lesion distribution and diffusion-weighted imaging findings" 28 : 1652-1658, 2007

10 Toris GT, "Hepatic encephalopathy:an updated approach from pathogenesis to treatment" 17 : RA53-RA63, 2011

11 Wakim-Fleming J, "Hepatic encephalopathy: suspect it early in patients with cirrhosis" 78 : 597-605, 2011

12 Kwak KP, "Bipolar Disorder" 50 : 348-356, 2007

13 Abouesh A, "Antimicrobial-induced mania (antibiomania):a review of spontaneous reports" 22 : 71-81, 2002