Department of Internal Medicine, St. Carolus Hospital, Jakarta, Indonesia.
Case Study
World Journal of Advanced Research and Reviews, 2024, 21(02), 1995–1998
Article DOI: 10.30574/wjarr.2024.21.2.0301
Received on 15 December 2023; revised on 06 January 2024; accepted on 08 January 2024
Acyclovir (ACV) is a widely utilized antiviral medication for treating herpes simplex virus, cytomegalovirus, and varicella-zoster virus (VZV). Despite its usefulness, ACV can lead to adverse effects like acute renal impairment. ACV is predominantly eliminated through the kidneys, and in cases of renal impairment, there exists a potential for elevated levels, posing a risk of subsequent neurotoxicity. This case highlights the challenges posed by ACV use in patients with compromised renal function. A 64-year-old female presented with unconsciousness persisting for several hours. She had recently self-administered acyclovir (5x800 mg) to manage a herpes zoster outbreak. She had history of Chronic Kidney Disease (CKD) Stage V but refused hemodialysis. She had irregular heart rate of 140-180 beats per minute (with EKG confirming Atrial Fibrillation Rapid Response), a respiratory rate of 26 breaths per minute. Other vital sign was stable. Physical examination identified herpes zoster lesions on the right abdomen. Laboratory results shown blood urea nitrogen of 266 mg/dL, creatinine 13.2 mg/dL, and potassium of 6.9 mmol/L . A month earlier, the level of blood urea nitrogen was 100 mg/dL and creatinine was 7.9 mg/dL, indicating a progressive deterioration in renal function. Given the severity of the patient's condition, hemodialysis was initiated. Over the course of five days, there was a notable improvement in both the patient's clinical condition and level of consciousness.
Acyclovir; End-Stage Renal Disease; Neurotoxicity; Herpes Zoster; Altered Mental Status
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Franzeska Madeline Chandra, Giovanni Reynaldo, Jinhee Cha and Fransiska. Severe acyclovir induced neurotoxicity in an elderly woman with end-stage renal disease and herpes zoster : A case report. World Journal of Advanced Research and Reviews, 2024, 21(2), 1995-1998. Article DOI: https://doi.org/10.30574/wjarr.2024.21.2.0301