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Acyclovir induced coma in the intensive care unit

G R Rajan1, J P Cobb, C K Reiss

  • 1Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri, USA. govindr@hotmail.com

Anaesthesia and Intensive Care
|June 15, 2000
PubMed

Insights

A patient developed coma after receiving enteral acyclovir for herpes labialis. This case highlights potential acyclovir neurotoxicity, even with oral administration, emphasizing the need for careful monitoring in critically ill patients.

Area of Science:

  • Neurology
  • Pharmacology
  • Infectious Diseases

Background:

  • Critically ill patients often require antiviral medications.
  • Herpes labialis is a common viral infection.
  • Acyclovir is a widely used antiviral agent.

Observation:

  • A 73-year-old man with multiorgan failure developed herpes labialis.
  • The patient was treated with enteral acyclovir.
  • Neurological impairment progressed to coma within seven days.

Findings:

  • Cerebral CT and CSF analysis were normal.
  • EEG revealed generalized slowing.
  • Discontinuation of acyclovir and institution of hemodialysis led to complete neurological recovery.

Implications:

  • This case suggests enteral acyclovir can cause neurotoxicity, leading to coma.
  • It is the first reported instance of coma attributed to enteral acyclovir.
  • Vigilance for acyclovir neurotoxicity is crucial, especially in patients with renal impairment or critical illness.

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