Johnson G L, Limon L, Trikha G, Wall H
Department of Pharmacy Services, Medical College of Virginia Hospitals, Richmond.
Ann Pharmacother. 1994 Apr;28(4):460-3. doi: 10.1177/106002809402800407.
To report a case of acute renal failure and neurotoxicity following administration of oral acyclovir.
Medical record of the patient, case reports identified by MEDLINE.
Data were abstracted from relevant published data by Johnson and reviewed by the remaining authors.
A 69-year-old woman was diagnosed with herpes zoster and oral acyclovir was prescribed by her local physician. After approximately two days the patient was taken to the emergency department of a local hospital with signs of acute confusion and acute renal failure. Medications included oxycodone/acetaminophen, alprazolam, prazepam, and digoxin. Pertinent laboratory abnormalities included serum digoxin 4.1 mumol/L, white blood cell count 17.6 x 10(9)/L, blood urea nitrogen (BUN) 24 mmol/L of urea, and serum creatinine 305 mumol/L (patient baseline is 11 mmol/L of urea and 91.5 serum creatinine mumol/L, respectively). Because of increasing lethargy and a focal seizure, she was transferred to our institution. Despite an extensive workup, no organic cause of her altered mental status and acute renal failure was identified. Four days after discontinuation of the acyclovir, without specific intervention, the patient's mental status improved and her BUN and serum creatinine concentrations had decreased to 21 mmol/L of urea and 190.6 mumol/L, respectively. On day 5, the patient was alert and oriented to name, place, year, and month. On day 9, her renal function and mental status had returned to baseline and she was discharged.
Acute renal failure and neurotoxicity are usually associated with intravenous acyclovir. The temporal relationship between the initiation of oral acyclovir therapy and the onset of adverse events, supported by published data of a few similar cases, strongly implicate oral acyclovir as the cause of this patient's acute renal failure and neurotoxicity. This case suggests that elderly patients with mild increased serum creatinine concentrations may be at increased risk and should be monitored closely for signs and symptoms of acute renal failure and neurotoxicity.
报告1例口服阿昔洛韦后出现急性肾衰竭和神经毒性的病例。
患者的病历、由医学期刊数据库检索到的病例报告。
数据由约翰逊从相关已发表数据中提取，并由其余作者审核。
一名69岁女性被诊断为带状疱疹，当地医生为其开了口服阿昔洛韦。大约两天后，患者因急性意识模糊和急性肾衰竭的症状被送往当地医院急诊科。所用药物包括羟考酮/对乙酰氨基酚、阿普唑仑、普拉西泮和地高辛。相关实验室异常结果包括血清地高辛4.1 μmol/L、白细胞计数17.6×10⁹/L、血尿素氮（BUN）24 mmol/L、血清肌酐305 μmol/L（患者基线分别为尿素11 mmol/L和血清肌酐91.5 μmol/L）。由于嗜睡加重并出现局灶性癫痫发作，她被转至我院。尽管进行了全面检查，但未发现导致其精神状态改变和急性肾衰竭的器质性病因。停用阿昔洛韦4天后，未进行特殊干预，患者的精神状态有所改善，其BUN和血清肌酐浓度分别降至21 mmol/L和190.6 μmol/L。第5天，患者意识清醒，能说出姓名、地点、年份和月份。第9天，她的肾功能和精神状态恢复至基线水平并出院。
急性肾衰竭和神经毒性通常与静脉注射阿昔洛韦有关。口服阿昔洛韦治疗开始与不良事件发生之间的时间关系，得到少数类似病例已发表数据的支持，强烈提示口服阿昔洛韦是该患者急性肾衰竭和神经毒性的病因。该病例表明，血清肌酐浓度轻度升高的老年患者可能风险增加，应密切监测急性肾衰竭和神经毒性的体征和症状。
