Strong D K, Hébert D
Department of Pharmacy, British Columbia's Children's Hospital, University of British Columbia, Vancouver, Canada.
Pediatr Nephrol. 1997 Dec;11(6):741-3. doi: 10.1007/s004670050379.
A 5-year-old girl with a kidney transplant developed post-transplant Epstein-Barr virus-induced lymphoproliferative disease. She was treated with acyclovir, alpha-interferon, and gamma globulin. A transplant nephrectomy was performed on day 4 due to acute rejection and she was started on hemodialysis. The acyclovir dose was decreased at this time. However, 6 days following the start of acyclovir she developed progressively worsening neurological symptoms resulting in a coma on day 8. Fourteen days after acyclovir was begun pre- and post-dose serum concentrations were 7.02 microM and 182.5 microM, respectively. Acyclovir was then discontinued and 2 days later the child's neurological status began to improve. We conclude that acyclovir in children with end-stage renal failure may lead to severe and reversible neurotoxicity, despite acyclovir dosage adjustment based on renal impairment.
一名接受肾移植的5岁女孩发生了移植后爱泼斯坦-巴尔病毒诱导的淋巴增殖性疾病。她接受了阿昔洛韦、α干扰素和丙种球蛋白治疗。由于急性排斥反应，在第4天进行了移植肾切除术，她开始接受血液透析。此时阿昔洛韦剂量减少。然而，在开始使用阿昔洛韦6天后，她的神经症状逐渐恶化，在第8天陷入昏迷。开始使用阿昔洛韦14天后，给药前和给药后的血清浓度分别为7.02微摩尔/升和182.5微摩尔/升。然后停用阿昔洛韦，2天后患儿的神经状态开始改善。我们得出结论，尽管根据肾功能损害调整了阿昔洛韦剂量，但终末期肾衰竭儿童使用阿昔洛韦可能会导致严重且可逆的神经毒性。
