Acute acyclovir neurotoxicity in a hemodialyzed child

Pediatr Nephrol. 1997 Dec;11(6):741-3. doi: 10.1007/s004670050379.


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.

Publication types

  • Case Reports

MeSH terms

  • Acyclovir / adverse effects*
  • Acyclovir / therapeutic use
  • Antiviral Agents / adverse effects*
  • Antiviral Agents / therapeutic use
  • Child, Preschool
  • Female
  • Humans
  • Kidney Transplantation
  • Lymphoproliferative Disorders / drug therapy
  • Lymphoproliferative Disorders / etiology
  • Nervous System Diseases / chemically induced*
  • Postoperative Complications / drug therapy
  • Renal Dialysis*


  • Antiviral Agents
  • Acyclovir