Takayanagi Akio, Maehana Takeshi, Kyoda Yuuki, Yanase Masahiro
The Department of Urology, Sunagawa City Medical Center, Japan.
Hinyokika Kiyo. 2010 Nov;56(11):617-9.
The patient was a 67-year-old man with a 2-year history of peritoneal dialysis for end-stage renal disease due to hypertensive nephropathy. He presented to a dermatologist with a complaint of pain in the right femoral region. He was diagnosed as having herpes zoster and valacyclovir, 1,000 mg/day, was prescribed. After 5 days of taking valacyclovir orally, he felt fretful and hallucinations appeared. He was admitted to our hospital and was hospitalized in our urology ward. We diagnosed his condition as neurotoxicity caused by an overdose of valacyclovir. As his general condition was stable, he was treated only by continuation of peritoneal dialysis. After 7 days of hospitalization, the neurotoxicity completely disappeared and he left the hospital. His serum acyclovir concentration at admission was 20.20 μg/l, and was reduced to 0.7 μg/l when he left the hospital. This supported our diagnosis of valacyclovir-induced neurotoxicity. In this case, valacyclovir should have been reduced to 500 mg/day, considering his renal function. Although we could treat the patient only by continuation of peritoneal dialysis, hemodialysis seems to be an effective treatment method in the case of unstable general condition or severe adverse effects, because it can eliminate the serum acyclovir.
患者为一名67岁男性，因高血压肾病导致终末期肾病，有2年腹膜透析病史。他因右股部疼痛就诊于皮肤科医生。他被诊断为带状疱疹，并开具了伐昔洛韦，每日1000毫克。口服伐昔洛韦5天后，他感到烦躁不安并出现幻觉。他被收治入我院并入住泌尿外科病房。我们将他的病情诊断为伐昔洛韦过量引起的神经毒性。由于他的一般情况稳定，仅通过继续腹膜透析进行治疗。住院7天后，神经毒性完全消失，他出院了。他入院时血清阿昔洛韦浓度为20.20微克/升，出院时降至0.7微克/升。这支持了我们对伐昔洛韦诱导神经毒性的诊断。在这种情况下，考虑到他的肾功能，伐昔洛韦的剂量本应减至每日500毫克。虽然我们仅通过继续腹膜透析治疗该患者，但在一般情况不稳定或出现严重不良反应的情况下，血液透析似乎是一种有效的治疗方法，因为它可以清除血清中的阿昔洛韦。
