Aciclovir-induced neurotoxicity.

Area of Science:

• Neurology
• Clinical Pharmacology

Background:

• Aciclovir neurotoxicity arises from the accumulation of aciclovir and its metabolite, 9-carboxymethoxymethylguanine (CMMG).
• This condition predominantly affects elderly patients with impaired renal function, presenting with confusion, psychiatric changes, and potentially seizures, myoclonus, or dysarthria.
• Peritoneal dialysis demonstrates limited efficacy in mitigating aciclovir's toxic effects.

Purpose of the Study:

• To report a case of aciclovir-induced neurotoxicity in an elderly patient with renal failure.
• To highlight the diagnostic challenges, particularly differentiating from viral encephalitis.
• To emphasize the importance of recognizing and diagnosing this underreported condition.

Main Methods:

• Case report of a woman in her 70s with renal failure.
• Clinical presentation included confusion and seizures post-aciclovir administration.
• Diagnosis confirmed by elevated serum CMMG concentration.

Main Results:

• The patient developed confusion and seizures after receiving aciclovir.
• Elevated serum CMMG confirmed aciclovir-induced neurotoxicity.
• The condition was successfully diagnosed and managed.

Conclusions:

• Aciclovir-induced neurotoxicity is likely underdiagnosed in clinical practice.
• Distinguishing this condition from viral encephalitis is a primary challenge for neurologists.
• Awareness and diagnostic confirmation through metabolite levels are essential for appropriate patient care.