Abstract
Background
Herpes zoster (zoster) also commonly known as “shingles,” occurs following re-activation
of the varicella zoster virus. It contributes a large cost burden to the U.S. health
care system, with an estimated 1 million cases costing $1 billion annually. The current
gold standard treatment is acyclovir, which limits viral replication. However, acyclovir
has been reported to cause neurotoxicity in patients with acute or chronic kidney
disease.
Case Report
This case presents an occurrence of acyclovir-induced toxic encephalopathy in a patient
with normal renal function. A 63-year-old male presented to the emergency department
with ataxia, tremors, fluctuating aphasia, confusion, agitation, and fatigue. Results
of imaging, lumbar puncture, and laboratory studies directed clinicians toward acyclovir
toxicity, despite a normal creatinine level.
Why Should an Emergency Physician Be Aware of This?
Emergency physicians will likely be the first point of contact in the health care
system following the onset of acyclovir toxicity. With an increasing incidence of
zoster disease, such atypical toxic manifestations may increase. Early recognition
is important to avoid permanent neurologic compromise.
Keywords
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Article info
Publication history
Published online: June 03, 2019
Accepted:
March 30,
2019
Received in revised form:
March 19,
2019
Received:
January 11,
2019
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
