Department of Neonatology, Yas Hospital Complex, Tehran University of Medical Sciences, Sarv Ave., North Nejatolahi Street, Tehran, 1598718311, Iran.
Maternal, Fetal, and Neonatal Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
J Med Case Rep. 2024 Jun 7;18(1):271. doi: 10.1186/s13256-024-04585-1.
Extravasation of infused drugs is not a rare problem in medical practice. Acyclovir is a vesicant and an antiviral medication commonly used for young children. In the present study, we presented a neonate with soft tissue damage due to acyclovir extravasation.
A female newborn (Iranian, Asian) with gestational age 37 weeks and breech presentation was born by Cesarean delivery from a mother with a recent history of Herpes simplex virus (HSV) infection (Yas Women's Hospital, Tehran, Iran). Intravenous administration of acyclovir was initiated through a peripheral catheter inserted on the dorsal side of the left hand. A few minutes after the second dose, the patient showed a diffused firm swelling, local discoloration, and induration in the dorsum of the hand. The peripheral catheter was removed immediately. Hyaluronidase was injected subcutaneously in five different regions around the catheterization site. Intermittent limb elevation and cold compression (for 10 minutes) were applied. Serial follow-ups and examinations were performed hourly to check limb inflammation, ischemia, and compartment syndrome. The limb swelling and discoloration significantly improved 4 hours after the second dose of hyaluronidase.
Early diagnosis of acyclovir extravasation and immediate management could prevent severe complications in neonates. Further studies are needed to suggest a standard approach and treatment protocol for acyclovir extravasation.
在医学实践中，药物外渗并不罕见。阿昔洛韦是一种具有刺激性的抗病毒药物，常用于儿童。本研究报告了一例因阿昔洛韦外渗导致新生儿软组织损伤的病例。
一名 37 周龄、臀位的伊朗籍女性新生儿，经剖宫产娩出，母亲近期患有单纯疱疹病毒（HSV）感染史（伊朗德黑兰 Yas 妇女医院）。通过插入左手背面的外周导管开始静脉给予阿昔洛韦。第二次给药后几分钟，患者手部背部出现弥漫性坚实肿胀、局部变色和硬结。立即拔除外周导管。在导管插入部位周围的五个不同区域皮下注射透明质酸酶。间歇性抬高肢体和冷敷（10 分钟）。每小时进行连续随访和检查，以检查肢体炎症、缺血和筋膜间室综合征。第二次注射透明质酸酶后 4 小时，肢体肿胀和变色明显改善。
早期诊断阿昔洛韦外渗并立即进行处理可预防新生儿发生严重并发症。需要进一步研究以提出阿昔洛韦外渗的标准处理方法和治疗方案。
