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.

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.

• Authors: Tsuneaki Kenzaka, Kazuma Sugimoto, Ken Goda, Hozuka Akita
• Journal: Medicine (Medicine (Baltimore)) Vol. 100 Issue 21 Pg. e26147 (May 28 2021) ISSN: 1536-5964 [Electronic] United States
• PMID: 34032768 (Publication Type: Case Reports, Journal Article, Review)
• Copyright: Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.

Chemical References

• Antiviral Agents
• Guanine
• Creatinine
• Valacyclovir
• 9-carboxymethoxymethylguanine

Topics

• Acute Kidney Injury (chemically induced, therapy)
• Aged, 80 and over
• Antiviral Agents (adverse effects)
• Brain Diseases (chemically induced)
• Creatinine (blood)
• Guanine (analogs & derivatives, blood)
• Herpes Zoster (blood, drug therapy, physiopathology)
• Humans
• Kidney (physiology)
• Male
• Reference Values
• Renal Dialysis
• Valacyclovir (adverse effects)