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Possible valacyclovir-related neurotoxicity and aseptic meningitis
Jacqueline L Olin1, Joseph L Gugliotta
1Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy at Rutgers, The State University of New Jersey, Piscataway, NJ, USA. fein.jacqueline@hunterdonhealthcare.org
The Annals of Pharmacotherapy
|November 25, 2003
Summary
Valacyclovir can cause neurotoxicity and aseptic meningitis. An 86-year-old patient developed these symptoms after starting valacyclovir, which resolved upon discontinuation. Healthcare providers should consider this adverse effect.
Area of Science:
- Neuroscience
- Pharmacology
- Infectious Disease
Background:
- Valacyclovir is an antiviral medication commonly prescribed for herpes infections.
- Drug-induced aseptic meningitis is a rare but serious adverse reaction to various medications.
Observation:
- An 86-year-old male presented with neurological symptoms including balance difficulties, headaches, and seizure after initiating valacyclovir for a herpetic rash.
- Cerebrospinal fluid analysis revealed elevated white blood cells and protein, indicative of meningitis, with a negative Gram stain.
Findings:
- Cerebrospinal fluid (CSF) analysis showed 162 white cells/mm(3), 1 red blood cell/mm(3), glucose 56 mg/dL, and protein 144 mg/dL.
- The patient's symptoms improved significantly after valacyclovir was discontinued and supportive care was provided.
- Valacyclovir-induced aseptic meningitis was considered a possible diagnosis based on the Naranjo probability scale, with only one prior reported case.
Implications:
- This case highlights valacyclovir as a potential cause of drug-induced aseptic meningitis.
- Clinicians should maintain a high index of suspicion for valacyclovir-induced aseptic meningitis in patients presenting with neurological symptoms.
- Awareness of this potential adverse effect is crucial for timely diagnosis and management, differentiating it from other causes of meningitis.