Ornidazole neurotoxic footprint: A comprehensive pediatric case report with follow up imaging

Nitroimidazoles, such as metronidazole and ornidazole, are widely used in pediatric patients, yet rare cases of ornidazole neurotoxicity have been reported. We present a 7-year-old boy who developed acute weakness, ataxia, and slurred speech after taking an over-the-counter tablet containing ornidazole drug for abdominal pain and diarrhea. Magnetic resonance imaging (MRI) showed symmetrical hyperintensities in the dentate nuclei, indicating a possible demyelinating or toxic condition. Ornidazole-induced neurotoxicity was confirmed based on clinical history and improvement upon drug discontinuation. Follow-up MRI after 2 months showed near-complete resolution. This case highlights the importance of recognizing ornidazole toxicity, understanding its specific imaging characteristics, and emphasizes the need for early diagnosis and careful medication review to avoid unnecessary investigations.