Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2021 May 28;100(21):e26147.
doi: 10.1097/MD.0000000000026147.

Acute kidney injury and acyclovir-associated encephalopathy after administration of valacyclovir in an elderly person with normal renal function: A case report and literature review

Tsuneaki Kenzaka  1   2 , Kazuma Sugimoto  1 , Ken Goda  1   2 , Hozuka Akita  1
Affiliations
Review

Acute kidney injury and acyclovir-associated encephalopathy after administration of valacyclovir in an elderly person with normal renal function: A case report and literature review

Tsuneaki Kenzaka et al. Medicine (Baltimore). .

Abstract

Introduction: Acyclovir (ACV)-associated encephalopathy is related to an increase in plasma levels of 9-carboxymethoxymethylguanine, an ACV metabolite, and is often reported in patients with renal dysfunction. We report a case of ACV-associated encephalopathy with rapid progression of renal dysfunction after oral administration of valacyclovir (VACV) and review literature of previous ACV-associated encephalopathy cases.

Patient concerns: An 88-year-old man was diagnosed with herpes zoster. VACV (3000 mg/day) treatment was initiated. Serum creatinine (Cr) level was 0.80 mg/dL. However, irritability, memory impairment, and decreased responsiveness occurred after 3 days. The Cr level was 6.76 mg/dL on admission.

Diagnosis: He was diagnosed with ACV-associated encephalopathy with acute kidney injury.

Interventions: VACV was discontinued, hemodialysis was initiated on the day of admission, and then the signs and symptoms improved approximately 72 hours after the admission.

Conclusion: Worsening of renal function and encephalopathy should be a focus when using VACV or ACV, regardless of age and original renal function. Acute kidney injury and ACV-associated encephalopathy may particularly occur in the elderly even when renal function is normal. Therefore, regular monitoring of renal function and consciousness is necessary during VACV treatment.

PubMed Disclaimer

Conflict of interest statement

The authors have no funding and conflicts of interests to disclose.

Figures

Figure 1
Figure 1
Clinical course.
See this image and copyright information in PMC

References

    1. Rashiq S, Briewa L, Mooney M, et al. . Distinguishing acyclovir neurotoxicity from encephalomyelitis. J Intern Med 1993;234:507–11. - PubMed
    1. Asahi T, Tsutsui M, Wakasugi M, et al. . Valacyclovir neurotoxicity: clinical experience and review of the literature. Eur J Neurol 2009;16:457–60. - PubMed
    1. Adair JC, Gold M, Bond RE. Acyclovir neurotoxicity: clinical experience and review of the literature. South Med J 1994;87:1227–31. - PubMed
    1. Sacchetti D, Alawadhi A, Albakour M, et al. . Herpes zoster encephalopathy or acyclovir neurotoxicity: a management dilemma. BMJ Case Rep 2014;2014: bcr2013201941. - PMC - PubMed
    1. Chowdhury MA, Derar N, Hasan S, et al. . Acyclovir-induced neurotoxicity: a case report and review of literature. Am J Ther 2016;23:e941–3. - PubMed