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[Cerebral and renal toxicity of acyclovir in a patient treated for meningoencephalitis]
M Da Conceiçao1, G Genco, J C Favier
1Service de réanimation polyvalente, HIA Legouest, Metz Armée, France.
Abstract:
We report the case of a 65-year-old man treated with intravenous acyclovir and amoxicilline for meningoencephalitis. Six days later, he suddenly developed acute renal failure, associated with central nervous system symptoms. The high acyclovir concentration in plasma and spinal fluid confirmed the hypothesis of acyclovir toxicity. Continuous haemofiltration resulted in a rapid amendment of neurologic and renal symptoms. Despite the high therapeutic index of acyclovir, manifestations of neurotoxicity and nephrotoxicity are not a rare event. The risk is increased in the elderly and in patients with renal insufficiency. Rapid intravenous injections are contraindicated. Continuous haemofiltration is rapidly efficient. The value of acyclovir concentration determination in plasma and spinal fluid are stressed.
Insights
A 65-year-old man experienced acute renal failure and central nervous system symptoms due to high acyclovir levels. Continuous hemodialysis rapidly resolved these toxic effects, highlighting the importance of monitoring acyclovir concentrations.
Area of Science:
- Pharmacology
- Nephrology
- Neurology
Background:
- Acyclovir is a widely used antiviral medication.
- Meningoencephalitis requires prompt treatment with antiviral agents like acyclovir.
Observation:
- A 65-year-old male patient developed acute renal failure and neurological symptoms six days after initiating intravenous acyclovir therapy for meningoencephalitis.
- Elevated acyclovir concentrations were detected in both plasma and cerebrospinal fluid.
- The patient's condition improved rapidly following continuous hemodialysis.
Findings:
- High plasma and spinal fluid acyclovir concentrations confirmed drug toxicity as the cause of neurotoxicity and nephrotoxicity.
- Continuous hemodialysis proved effective in rapidly clearing acyclovir and reversing clinical symptoms.
- The risk of acyclovir toxicity is elevated in elderly patients and those with pre-existing renal insufficiency.
Implications:
- Monitoring acyclovir levels in plasma and cerebrospinal fluid is crucial for early detection of toxicity.
- Continuous hemodialysis is an efficient treatment modality for managing severe acyclovir-induced neurotoxicity and nephrotoxicity.
- Avoiding rapid intravenous administration of acyclovir is recommended, particularly in at-risk populations.