Valacyclovir Neurotoxicity and Nephrotoxicity in an Elderly Patient Complicated by Hyponatremia

Abstract

A 66-year-old women with no history of renal disease was admitted due to a coma and acute kidney injury with a serum creatinine level of 7.44 mg/dL which were ascribed to valacyclovir neurotoxicity and nephrotoxicity, respectively. She had received valacyclovir at a standard dosage for the treatment of herpes zoster and was finally discharged, having fully returned to her normal baseline mental status with a recovered serum creatinine level of 0.68 mg/dL. We feel that awareness of this pathology remains a challenge for physicians and therefore strongly recommend the further accumulation of experiences similar to our own. Our experience underscores the pitfalls of administering valacyclovir to elderly patients who barely appear to have a favorable renal function. Several concerns regarding the therapeutic management, including blood purification strategies, that emerged in this case are also discussed.

Keywords: Valacyclovir neurotoxicity; acute kidney injury; hemodialysis; hyponatremia; osmotic demyelination syndrome.

Figure 1.

Serial changes in the sCr, serum sodium levels, and urine volume during the observation period. HF and HP were performed on hospital days 1 and 2, respectively, whereas the patient received the HD treatment on hospital days 3 and 5. The administration of intravenous hypertonic saline was ceased after confirming that the patient’s serum sodium level had been corrected to 139 mmol/L on hospital day 3.