Hong Xiaowei, Wang Xiaoqian, Wang Zhiyong
Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, 210008, People's Republic of China.
State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, People's Republic of China.
BMC Pharmacol Toxicol. 2017 Mar 7;18(1):12. doi: 10.1186/s40360-017-0120-2.
Acyclovir has been widely used to treat infections caused by herpes simplex virus (HSV) and varicella zoster virus (VZV). The common adverse effects of this drug include nausea, diarrhea, headache, dizziness and mental changes. The immune thrombocytopenia induced by acyclovir is rare.
A 67-year-old Chinese male who was given acyclovir 5 mg kg 8 hourly intravenously for treatment of VZV infection developed severe thrombocytopenia with fist sign in oral cavity within 10 days of starting using acyclovir. The patient's condition was improved by stopping using acyclovir and further supportive treatment. The acyclovir-dependent platelet antibody test showed positive results, which implicated acyclovir as the causative agent. The final definitive diagnosis of acyclovir-induced immune thrombocytopenia was established basing on the time correlation between the start of using acyclovir and the onset of symptoms of thrombocytopenia, combining with excluding of other common causes of thrombocytopenia.
There have been few reports of acyclovir-induced immune thrombocytopenia. This is the first case report and literature review of acyclovir-induced immune thrombocytopenia, with tongue hematoma as the first sign. Dentists should never overlook this rare adverse effect of acyclovir, as a rapid and appropriate treatment may prevent further severe life-threatening complications.
阿昔洛韦已被广泛用于治疗由单纯疱疹病毒（HSV）和水痘带状疱疹病毒（VZV）引起的感染。该药物的常见不良反应包括恶心、腹泻、头痛、头晕和精神改变。阿昔洛韦诱发的免疫性血小板减少症较为罕见。
一名67岁中国男性，因治疗VZV感染，每8小时静脉注射5mg/kg阿昔洛韦，在开始使用阿昔洛韦10天内出现严重血小板减少症，并伴有口腔瘀斑。停用阿昔洛韦并进行进一步支持治疗后，患者病情有所改善。阿昔洛韦依赖性血小板抗体检测呈阳性，提示阿昔洛韦为致病因素。根据开始使用阿昔洛韦与血小板减少症状发作之间的时间相关性，并排除其他常见的血小板减少原因，最终确诊为阿昔洛韦诱发的免疫性血小板减少症。
关于阿昔洛韦诱发免疫性血小板减少症的报道较少。这是首例以舌部血肿为首发症状报告阿昔洛韦诱发免疫性血小板减少症的病例及文献综述。牙医不应忽视阿昔洛韦这种罕见的不良反应，因为快速且恰当的治疗可预防进一步严重的危及生命的并发症。
