P59?Acute varicella zoster encephalitis? Don’t forget the treatment!

摘要

Educate physicians on the need for monitoring of Aciclivir levels in renal failure.Retrospective case report.59?year old woman presented with acute psychosis following recent herpes zoster treated with oral Aciclovir.Data collection from; original casenotes, electronic laboratory records, electronic picture archiving and communication system (PACS).Lumbar puncture showed raised protein (0.92?g/L), CSF:serum glucose ratio(0.9), 36 WBCs/cmm(72% polymorphs) and detection of VZV DNA. MRI brain only revealed intracranial-hypotension secondary to lumbar puncture. Despite absence of VZV DNA on surveillance lumbar puncture, she remained minimally responsive. Aciclovir levels were significantly elevated post-dose at 32.7?mg/L (cutoff 10.8?mg/L) and a sedation hold revealed temporal correlation of pre-dose levels (6.4?mg/L) with improvement of GCS, strongly implicating Aciclovir as causative agent. Rapid resolution of encephalopathy occurred upon cessation with no residual neurological compromise.Aciclovir neurotoxicity mimics zoster-related encephalitis and VZV DNA is commonly detected in cerebrospinal fluid of patient’s with herpes zoster (Rudzek Rudzek D, Piskunova N, Zampachova E. High variability in viral load in cerebrospinal fluid from patients with herpes simplex and varicella-zoster infections of the central nervous system. Clinical Microbiology and Infection2007;13(12):1217–1219.