Acyclovir-induced neurotoxicity in an immunocompromised patient
Daniel Marks1, Andrew De La Paz2, Bobbi Jo Walston3
1School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
SAGE Open Medical Case Reports
|August 28, 2020
Summary
A case report highlights that intravenous acyclovir can cause neurotoxicity in immunocompromised patients, leading to encephalopathy. Discontinuing the drug resolved the patient
Area of Science:
- Neurology
- Infectious Diseases
Background:
- Disseminated herpes zoster can affect immunocompromised individuals.
- Standard treatment involves intravenous acyclovir.
Observation:
- A 75-year-old immunocompromised male presented with lower extremity weakness due to disseminated herpes zoster.
- Following initiation of intravenous acyclovir, he developed progressive encephalopathy, confusion, and obtundation.
- Neurological evaluations were unremarkable.
Findings:
- The patient's neurological symptoms resolved after discontinuation of intravenous acyclovir.
- This presentation is consistent with acyclovir-induced neurotoxicity.
- Risk factors for acyclovir neurotoxicity include renal impairment and immunocompromised status.
Implications:
- Clinicians should consider acyclovir neurotoxicity in immunocompromised patients presenting with altered mental status during treatment.
- Early recognition and drug discontinuation are crucial for symptom resolution.
- This case underscores the importance of monitoring neurological function in patients receiving antiviral therapy.
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