Journal of Yeungnam Medical Science

Yeungnam University College of Medicine, Yeungnam University Institute Medical Science (영남대 의대 학술지 편집위원회)
권호 표지

A Case of Neurotoxicity Induced by Valaciclovir in a Continuous Ambulatory Peritoneal Dialysis Patient

Valaciclovir 복용 후 중추신경계 부작용을 보였던 복막투석 환자 1예

  • Kim, Joon-Seok (Department of Internal Medicine, Asan Medical Center, University of Ulsan, College of Medicine) ;
  • Yang, Jee Eun (Department of Internal Medicine, Asan Medical Center, University of Ulsan, College of Medicine) ;
  • Lee, Bo Young (Department of Internal Medicine, Asan Medical Center, University of Ulsan, College of Medicine) ;
  • Lee, Seohyun (Department of Internal Medicine, Asan Medical Center, University of Ulsan, College of Medicine) ;
  • Park, Hee Jung (Department of Internal Medicine, Asan Medical Center, University of Ulsan, College of Medicine) ;
  • Lee, Sunpyo (Department of Internal Medicine, Asan Medical Center, University of Ulsan, College of Medicine) ;
  • Lee, Sang Koo (Department of Internal Medicine, Asan Medical Center, University of Ulsan, College of Medicine)
  • 김준석 (울산대학교 의과대학 서울아산병원 신장내과) ;
  • 양지은 (울산대학교 의과대학 서울아산병원 신장내과) ;
  • 이보영 (울산대학교 의과대학 서울아산병원 신장내과) ;
  • 이서현 (울산대학교 의과대학 서울아산병원 신장내과) ;
  • 박희정 (울산대학교 의과대학 서울아산병원 신장내과) ;
  • 이선표 (울산대학교 의과대학 서울아산병원 신장내과) ;
  • 이상구 (울산대학교 의과대학 서울아산병원 신장내과)
  • Received : 2012.07.20
  • Accepted : 2012.08.28
  • Published : 2012.12.31
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Abstract

Valaciclovir is metabolized to acyclovir after ingestion and thereafter exerts its antiviral activity. Because of its superior pharmacokinetic profile, it has quickly replaced acyclovir in the treatment of herpesvirus infection. Neurotoxicity caused by valaciclovir has been reported, however, among patients with pre-existing impaired renal function. This paper reports a case of neurotoxicity of valaciclovir in a patient with end-stage renal disease who was undergoing continuous ambulatory peritoneal dialysis (CAPD). A 67-year-old female on CAPD took 500 mg of valaciclovir twice for herpes zoster. After she took her second dose orally, she developed confusion and disorientation, along with involuntary movements. Her mental confusion progressed to a coma. Discontinuation of valaciclovir showed no rapid improvement. There- fore, hemodialysis was started. After two sessions of hemodialysis, the patient became alert; and after four sessions of hemodialysis, her neurological abnormalities were completely reversed. In conclusion, valaciclovir can induce life-threatening neurotoxicity, especially in CAPD patients, even with appropriate dose reduction, which can be effectively managed by hemodialysis.

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