Olin Jacqueline L, Gugliotta Joseph L
Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy at Rutgers, The State University of New Jersey, Piscataway, NJ, USA.
Ann Pharmacother. 2003 Dec;37(12):1814-7. doi: 10.1345/aph.1D171.
To report a case of neurotoxicity and aseptic meningitis in a patient receiving valacyclovir.
An 86-year-old white man had started valacyclovir 1 g 3 times a day for a herpetic rash along the left side of his face. He subsequently presented with balance difficulties, constant frontal headaches, and a seizure 1 day prior to admission. Cerebral spinal fluid (CSF) analysis revealed 162 white cells/mm(3), 1 red blood cell/mm(3), glucose 56 mg/dL, and protein 144 mg/dL, with a negative Gram stain. Further laboratory examination failed to demonstrate other causes for the patient's clinical picture. After discontinuation of valacyclovir and supportive care, the patient symptomatically improved.
As of the third week of September 2003, only 1 other case of valacyclovir-related aseptic meningitis was published describing a patient with characteristics similar to those of our patient. Our patient's neurologic symptoms may have been due to acyclovir toxicity, but acyclovir-toxic patients present with normal CSF findings. Several drug classes, including nonsteroidal antiinflammatory drugs, antibiotics, and intravenous immunoglobulins, can induce aseptic meningitis. Other reasons for the patient's symptoms or causes of meningitis were excluded, although viral meningitis remains a possibility. Valacyclovir-induced aseptic meningitis was considered to be possible according to the Naranjo probability scale.
Healthcare providers should be aware of valacyclovir as a possible cause of drug-induced aseptic meningitis.
报告1例接受伐昔洛韦治疗的患者发生神经毒性和无菌性脑膜炎的病例。
一名86岁白人男性因左侧面部疱疹性皮疹开始每天3次服用1g伐昔洛韦。入院前1天，他出现平衡困难、持续性前额头痛和癫痫发作。脑脊液（CSF）分析显示白细胞162/mm³、红细胞1/mm³、葡萄糖56mg/dL、蛋白质144mg/dL，革兰氏染色阴性。进一步实验室检查未能发现导致该患者临床表现的其他原因。停用伐昔洛韦并给予支持治疗后，患者症状有所改善。
截至2003年9月第三周，仅发表了1例与伐昔洛韦相关的无菌性脑膜炎病例，描述的患者特征与我们的患者相似。我们患者的神经症状可能是由于阿昔洛韦毒性，但阿昔洛韦中毒患者的脑脊液检查结果正常。包括非甾体抗炎药、抗生素和静脉注射免疫球蛋白在内的几类药物可诱发无菌性脑膜炎。尽管病毒性脑膜炎仍有可能，但已排除患者症状的其他原因或脑膜炎的病因。根据Naranjo概率量表，考虑伐昔洛韦诱发无菌性脑膜炎是可能的。
医疗保健人员应意识到伐昔洛韦可能是药物性无菌性脑膜炎的一个病因。
