Herpes zoster encephalopathy or acyclovir neurotoxicity: a management dilemma

Daniel Sacchetti

Aydah Alawadhi

Mustafa Albakour

Alwyn Rapose

^{Department of Internal Medicine, Saint Vincent Hospital, Worcester, Massachusetts, USA}

^{Department of Internal Medicine, Reliant Medical Group, Worcester, Massachusetts, USA}

^{Department of Infectious Diseases,, Reliant Medical Group and Saint Vincent Hospital, Worcester, Massachusetts, USA}

^{Dr Alwyn Rapose,}moc.liamg@esopar.nywla

Accepted 2014 Apr 4.

Abstract

This is a case report of a 69-year-old morbidly obese woman who presented with mental status changes after she was treated with acyclovir for shingles. The predominant symptoms were word-finding difficulties and visual hallucinations. Complicating her presentation was acyclovir-induced acute renal injury causing her creatinine level to rise up to 7.4 mg/dL. Acyclovir was discontinued on the suspicion of acyclovir neurotoxicity. Even though PCR for varicella zoster virus in the cerebrospinal fluid was positive, acyclovir was not restarted and the patient continued to improve and returned to her baseline.

Abstract

Learning points

Footnotes

Contributors: All the authors have contributed to the case and have been involved with writing as well as reviewing the drafts and the final version.

Competing interests: None.

Patient consent: Obtained.

Provenance and peer review: Not commissioned; externally peer reviewed.

Footnotes

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