Iranian Red Crescent Medical Journal

Published by: Kowsar

In Vivo Confocal Microscopic Analysis of Keratitis Induced by Anaphylaxis to Intravenous Metronidazole: A Case Report and Literature Review

Cheng-Wei Lu 1 , Zhi-Hua Cui 1 , Xiao-Feng Qi 1 , Om Prakash Pant 1 , Cheng-Bo Lu 2 , Ji-Long Hao 1 and Dan-Dan Zhou 3 , *
Authors Information
1 Department of Ophthalmology, The First Hospital of Jilin University, Changchun, China
2 Department of Cardiology, The First Affiliated Hospital of Jiamusi University, Heilongjiang, China
3 Department of Radiology, The First Hospital of Jilin University, Changchun, China
Article information
  • Iranian Red Crescent Medical Journal: 21 (1); e84698
  • Published Online: January 15, 2019
  • Article Type: Case Report
  • Received: September 28, 2018
  • Revised: December 28, 2018
  • Accepted: January 5, 2019
  • DOI: 10.5812/ircmj.84698

To Cite: Lu C, Cui Z , Qi X , Pant O P, Lu C, et al. In Vivo Confocal Microscopic Analysis of Keratitis Induced by Anaphylaxis to Intravenous Metronidazole: A Case Report and Literature Review, Iran Red Crescent Med J. Online ahead of Print ; 21(1):e84698. doi: 10.5812/ircmj.84698.

Copyright © 2019, Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License ( which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited
1. Introduction
2. Case Presentation
3. Discussion
  • 1. Blomquist PH. Ocular complications of systemic medications. Am J Med Sci. 2011;342(1):62-9. doi: 10.1097/MAJ.0b013e3181f06b21. [PubMed: 21139494].
  • 2. Mergen B, Ozdamar A, Sarici AM. Ring keratitis from topical anesthetic abuse after laser epithelial keratomileusis. Eye Contact Lens. 2018;44 Suppl 1:S365-7. doi: 10.1097/ICL.0000000000000433. [PubMed: 28945650].
  • 3. Sedaghat MR, Sagheb Hosseinpoor S, Abrishami M. Neurotrophic corneal ulcer after topical tetracaine abuse: Management guidelines. Iran Red Crescent Med J. 2011;13(1):55-7. [PubMed: 22946020]. [PubMed Central: PMC3407587].
  • 4. Silverstein SM, Rana VK, Stephens R, Segars L, Pankratz J, Rana S, et al. Effect of phenylephrine 1.0%-ketorolac 0.3% injection on tamsulosin-associated intraoperative floppy-iris syndrome. J Cataract Refract Surg. 2018;44(9):1103-8. doi: 10.1016/j.jcrs.2018.05.029. [PubMed: 30078537].
  • 5. Neufeld A, Warner J. Case of bilateral sequential nonarteritic ischemic optic neuropathy after rechallenge with sildenafil. J Neuroophthalmol. 2018;38(1):123-4. doi: 10.1097/WNO.0000000000000615. [PubMed: 29215388].
  • 6. Mahendradas P, Parab S, Sasikumar R, Kawali A, Shetty BK. Topiramate-induced acute angle closure with severe panuveitis: A challenging case report. Indian J Ophthalmol. 2018;66(9):1342-4. doi: 10.4103/ijo.IJO_1192_17. [PubMed: 30127167]. [PubMed Central: PMC6113830].
  • 7. Schmid KE, Kornek GV, Scheithauer W, Binder S. Update on ocular complications of systemic cancer chemotherapy. Surv Ophthalmol. 2006;51(1):19-40. doi: 10.1016/j.survophthal.2005.11.001. [PubMed: 16414359].
  • 8. Al Hanaineh AT, Hassanein DH, Abdelbaky SH, El Zawahry OM. Steroid-induced ocular hypertension in the pediatric age group. Eur J Ophthalmol. 2018;28(4):372-7. doi: 10.1177/1120672118757434. [PubMed: 29554813].
  • 9. Yusuf IH, Sharma S, Luqmani R, Downes SM. Hydroxychloroquine retinopathy. Eye (Lond). 2017;31(6):828-45. doi: 10.1038/eye.2016.298. [PubMed: 28282061]. [PubMed Central: PMC5518824].
  • 10. VanCleave HZ, Sanchez AC, Lieberman JA, Ellenburg JT, Mabry WA. Probable metronidazole induced serum sickness-like reaction in a paediatric patient. J Clin Pharm Ther. 2016;41(6):736-8. doi: 10.1111/jcpt.12448. [PubMed: 27663456].
  • 11. Lofmark S, Edlund C, Nord CE. Metronidazole is still the drug of choice for treatment of anaerobic infections. Clin Infect Dis. 2010;50 Suppl 1:S16-23. doi: 10.1086/647939. [PubMed: 20067388].
  • 12. Tang AW. A practical guide to anaphylaxis. Am Fam Physician. 2003;68(7):1325-32. [PubMed: 14567487].
  • 13. Kancherla D, Gajendran M, Vallabhaneni P, Vipperla K. Metronidazole induced liver injury: A rare immune mediated drug reaction. Case Rep Gastrointest Med. 2013;2013:568193. doi: 10.1155/2013/568193. [PubMed: 24455335]. [PubMed Central: PMC3884854].
  • 14. Patel K, Green-Hopkins I, Lu S, Tunkel AR. Cerebellar ataxia following prolonged use of metronidazole: Case report and literature review. Int J Infect Dis. 2008;12(6):e111-4. doi: 10.1016/j.ijid.2008.03.006. [PubMed: 18511323].
  • 15. Sorensen CG, Karlsson WK, Amin FM, Lindelof M. Metronidazole-induced encephalopathy: A systematic review. J Neurol. 2018. doi: 10.1007/s00415-018-9147-6. [PubMed: 30536109].
  • 16. Fogagnolo P, Sacchi M, Ceresara G, Paderni R, Lapadula P, Orzalesi N, et al. The effects of topical coenzyme Q10 and vitamin E D-alpha-tocopheryl polyethylene glycol 1000 succinate after cataract surgery: A clinical and in vivo confocal study. Ophthalmologica. 2013;229(1):26-31. doi: 10.1159/000342196. [PubMed: 23011409].
  • 17. Fogagnolo P, Dipinto A, Vanzulli E, Maggiolo E, De Cilla S, Autelitano A, et al. A 1-year randomized study of the clinical and confocal effects of tafluprost and latanoprost in newly diagnosed glaucoma patients. Adv Ther. 2015;32(4):356-69. doi: 10.1007/s12325-015-0205-5. [PubMed: 25893514]. [PubMed Central: PMC4415941].
  • 18. Suttorp-Schulten MS, Nunes-Cardozo B, Breebaart AC, Kijlstra A. The fate of antigen-antibody complexes in the rabbit cornea. Curr Eye Res. 1991;10(8):773-8. doi: 10.3109/02713689109013871. [PubMed: 1914509].
  • 19. Fini ME. Keratocyte and fibroblast phenotypes in the repairing cornea. Prog Retin Eye Res. 1999;18(4):529-51. doi: 10.1016/S1350-9462(98)00033-0. [PubMed: 10217482].
  • 20. Dana MR. Corneal antigen-presenting cells: diversity, plasticity, and disguise: The Cogan lecture. Invest Ophthalmol Vis Sci. 2004;45(3):722-7. 721. [PubMed: 14985280].
  • 21. Zhivov A, Stave J, Vollmar B, Guthoff R. In vivo confocal microscopic evaluation of Langerhans cell density and distribution in the normal human corneal epithelium. Graefes Arch Clin Exp Ophthalmol. 2005;243(10):1056-61. doi: 10.1007/s00417-004-1075-8. [PubMed: 15856272].
  • 22. Liu M, Gao H, Wang T, Wang S, Li S, Shi W. An essential role for dendritic cells in vernal keratoconjunctivitis: Analysis by laser scanning confocal microscopy. Clin Exp Allergy. 2014;44(3):362-70. doi: 10.1111/cea.12264. [PubMed: 24372712].
  • 23. Mastropasqua L, Nubile M, Lanzini M, Carpineto P, Ciancaglini M, Pannellini T, et al. Epithelial dendritic cell distribution in normal and inflamed human cornea: In vivo confocal microscopy study. Am J Ophthalmol. 2006;142(5):736-44. doi: 10.1016/j.ajo.2006.06.057. [PubMed: 17056357].

Featured Image:

Creative Commons License Except where otherwise noted, this work is licensed under Creative Commons Attribution Non Commercial 4.0 International License .

Search Relations:



Create Citiation Alert
via Google Reader

Readers' Comments