Successful Treatment of Valacyclovir Neurotoxicity in a Hemodialysis Patient

Valacyclovir neurotoxicity is a sporadic and rare complication of valacyclovir administration with diverse neurologic manifestations. Most of the reported cases were associated with chronic kidney disease. Up to date, there is no diagnostic criterion proposed for valacyclovir neurotoxicity. Hemodialysis has been reported to be effective in prompt recovery from neurological complications. We report herein an 87-year-old woman with end-stage renal disease diagnosed with herpes zoster and under oral valacyclovir treatment. Four hours after valacyclovir administration, the patient began to suffer rapidly progressive neurologic decline and she was admitted to our hospital due to coma 2 days later. The neurological examination did not reveal manifestations indicating herpes zosterassociated encephalitis. Biochemistry tests and brain computed tomography could not find evidences related to acute conscious disturbance. In addition, no psychotropic medications were used. Under high clinical suspicion of valacyclovir neurotoxicity, hemodialysis was administered on two consecutive days and the patient recovered after the second course of hemodialysis.

並列關鍵字

chronic kidney failure ； hemodialysis ； herpes zoster encephalitis ； valacyclovir neurologic disorder ； zoster

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