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Aciclovir-induced neurotoxicity
  1. Frederick William Vonberg1,2,
  2. Angelo Dawson1,
  3. Gregory Scott1,3,
  4. Nicholas Davies1,2
  1. 1Department of Neurology, Imperial College Healthcare NHS Trust, London, UK
  2. 2Department of Neurology, Chelsea and Westminster Healthcare NHS Trust, London, UK
  3. 3Imperial College London, London, UK
  1. Correspondence to Dr Frederick William Vonberg, Department of Neurology, Imperial College Healthcare NHS Trust, London, W2 1NY, UK; frederick.vonberg{at}nhs.net

Abstract

Aciclovir-induced neurotoxicity results from the accumulation of aciclovir and its metabolite 9-carboxymethoxymethylguanine (CMMG). It occurs predominantly in older patients with impaired renal function and is characterised by a combination of confusion and psychiatric changes. Seizures, myoclonus and dysarthria may also occur. Critically, peritoneal dialysis has little effect on reversing the toxic effects of aciclovir. We describe a woman in her 70s with renal failure who developed confusion and seizures after receiving aciclovir. She was ultimately diagnosed with aciclovir-induced neurotoxicity, confirmed by an elevated serum CMMG concentration. This condition is likely to be underdiagnosed and the neurologist’s primary challenge is differentiating aciclovir-induced neurotoxicity from viral encephalitis.

  • NEUROTOXICOLOGY
  • PHARMACOLOGY

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Footnotes

  • Contributors Article conceived, prepared and written by FWV, review and edits made by AD, GS, and ND. Supervision provided by ND.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed by Lucy Kinton, Southampton, UK.

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