Acute acyclovir neurotoxicity in a hemodialyzed child.
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.
Strong
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Department of Pharmacy, British Columbia's Children's Hospital, University of British Columbia, Vancouver, Canada.
Hébert
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D000212:Acyclovir / Q000009:adverse effects* / Q000627:therapeutic use; D000998:Antiviral Agents / Q000009:adverse effects* / Q000627:therapeutic use; D002675:Child, Preschool; D005260:Female; D006801:Humans; D016030:Kidney Transplantation; D008232:Lymphoproliferative Disorders / Q000188:drug therapy / Q000209:etiology; D009422:Nervous System Diseases / Q000139:chemically induced*; D011183:Postoperative Complications / Q000188:drug therapy; D006435:Renal Dialysis
D000998:Antiviral Agents; D000212:Acyclovir