Abstract
Neurotoxicity is well known to be associated with intravenous acyclovir (ACV) therapy. A 62-year-old man on CAPD was admitted to our hospital with fatigue and loss of appetite on September 27, 1999. He developed varicellazoster virus (VZV) skin eruption on the left side of the abdomen on October 18 and was treated with intravenous acyclovir (2.5mg/kg) once daily. He became disoriented in time and place with hallucinations and delirium two days after starting ACV therapy. We stopped ACV infusion, but the serum ACV level remained elevated to 30.0μM. His symptoms resolved within two days. The serum ACV level decreased to 0.8μM on the 3rd day and was less than 0.1μM on the 7th day.
Great care is needed before prescribing intravenous ACV for dialysis patients and it is imperative to control the serum ACV level using hemodialysis or apheresis.
