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Aciclovir-induced neurotoxicity.

Frederick William Vonberg1,2, Angelo Dawson3, Gregory Scott3,4

  • 1Department of Neurology, Imperial College Healthcare NHS Trust, London, UK frederick.vonberg@nhs.net.

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PubMed
Summary
This summary is machine-generated.

Aciclovir neurotoxicity, caused by drug accumulation in patients with poor kidney function, can lead to confusion and seizures. Early diagnosis is crucial as it is often underdiagnosed and mistaken for infections like viral encephalitis.

Keywords:
NEUROTOXICOLOGYPHARMACOLOGY

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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.