A case of acyclovir neurotoxicity presenting with atypical cerebrospinal fluid findings.
BMJ Case Rep
; 20172017 May 22.
Article
in En
| MEDLINE
| ID: mdl-28536235
ABSTRACT
An 82-year-old man with a history of end-stage renal disease presented with progressively worsening confusion and somnolence for the past 4-5 days. The patient was diagnosed with herpes zoster by his primary care physician 5 days ago and was started on a course of valacyclovir 1 g three times a day (dose not adjusted for renal impairment).A lumbar puncture was performed and cerebrospinal fluid (CSF) studies revealed 37 white blood cells (WBCs)/hpf (100% monocytes), protein 64 mg/dL and glucose 52 mg/dL. He was started on ceftriaxone, ampicillin and acyclovir. MRI of the brain was done and was unremarkable. Acyclovir-induced encephalopathy was high on differential, but his CSF findings were concerning for viral encephalitis. Nonetheless, all antimicrobials were discontinued and he was scheduled for a 5-hour dialysis session. The very next day, he showed immense improvement and eventually recovered completely. CSF PCR tests for both herpes simplex virus and varicella zoster virus came back negative.
Key words
Full text:
1
Database:
MEDLINE
Main subject:
Antiviral Agents
/
Valine
/
Acyclovir
/
Neurotoxicity Syndromes
Type of study:
Diagnostic_studies
Limits:
Aged80
/
Humans
/
Male
Language:
En
Journal:
BMJ Case Rep
Year:
2017
Type:
Article
Affiliation country:
United States