Kawabe Matsukawa Miho, Suzuki Yuya, Ikuma Daisuke, Suwabe Tatsuya, Uesaka Yoshikazu, Sugimoto Izumi
Department of Neurology, Toranomon Hospital Kajigaya.
Nephrology Center, Toranomon Hospital Kajigaya.
Rinsho Shinkeigaku. 2019 Dec 25;59(12):834-839. doi: 10.5692/clinicalneurol.cn-001355. Epub 2019 Nov 23.
We report a case of acyclovir encephalopathy in a 77-year-old man who was introduced to peritoneal dialysis three years earlier. He developed herpes zoster and was treated with acyclovir (ACV) at 800 mg daily per oral. Two days later, he developed consciousness disturbance, hallucinations and asterixis. Acyclovir was stopped and continuous ambulatory peritoneal dialysis (CAPD) was switched to hemodialysis, which resulted in the resolution of his symptoms. Because the optimal dose of ACV varies among individuals depending on the bioavailability of ACV and metabolic enzyme activity, ACV encephalopathy can occur even when the acyclovir dose is modified according to the renal function of the affected patient. Because CAPD provides a poorer ACV clearance than hemodialysis, CAPD patients tend to have a higher risk of developing ACV encephalopathy and to recover more slowly. If CAPD patients develop ACV encephalopathy, a temporary change in the type of dialysis to hemodialysis should be considered.
我们报告一例77岁男性的阿昔洛韦脑病病例，该患者三年前开始接受腹膜透析治疗。他患了带状疱疹，接受口服阿昔洛韦（ACV）每日800mg治疗。两天后，他出现意识障碍、幻觉和扑翼样震颤。停用阿昔洛韦，并将持续性非卧床腹膜透析（CAPD）改为血液透析，其症状得以缓解。由于阿昔洛韦的最佳剂量因个体差异而异，取决于阿昔洛韦的生物利用度和代谢酶活性，即使根据受影响患者的肾功能调整阿昔洛韦剂量，也可能发生阿昔洛韦脑病。由于CAPD对阿昔洛韦的清除能力比血液透析差，CAPD患者发生阿昔洛韦脑病的风险往往更高，且恢复更慢。如果CAPD患者发生阿昔洛韦脑病，应考虑暂时将透析方式改为血液透析。
