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Acyclovir-induced thrombotic microangiopathy

R Goli1, K K Mukku1, S B R Devaraju1

  • 1Department of Nephrology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India.

Indian Journal of Nephrology
|March 31, 2017
PubMed

Insights

Acyclovir can cause acute kidney injury (AKI) through crystal formation. This case report details AKI mimicking thrombotic microangiopathy, with partial recovery after plasmapheresis.

Area of Science:

  • Nephrology
  • Pharmacology
  • Virology

Background:

  • Acyclovir is a widely prescribed antiviral medication.
  • Acute kidney injury (AKI) from acyclovir is typically associated with intratubular crystal precipitation and interstitial nephritis.
  • Thrombotic microangiopathy is a serious condition characterized by microangiopathic hemolytic anemia, thrombocytopenia, and organ damage.

Observation:

  • A 61-year-old male with herpes zoster developed AKI.
  • The patient's presentation mimicked thrombotic microangiopathy.
  • Renal biopsy revealed acute interstitial nephritis.

Findings:

  • This case highlights acyclovir-induced AKI presenting atypically as thrombotic microangiopathy.
  • It is the first reported instance of acyclovir causing thrombotic microangiopathy.
  • Partial improvement in renal function was observed following plasmapheresis treatment.

Implications:

  • Clinicians should consider acyclovir as a potential cause of AKI, even with atypical presentations like thrombotic microangiopathy.
  • Early recognition and intervention, potentially including plasmapheresis, may improve outcomes.
  • This case expands the known spectrum of renal adverse effects associated with acyclovir therapy.
Keywords:
Acute kidney injuryacyclovirthrombotic microangiopathy

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