Valacyclovir Neurotoxicity and Nephrotoxicity in an Elderly Patient Complicated by Hyponatremia

Takuya Murakami; Tetsu Akimoto; Mari Okada; Erika Hishida; Taro Sugase; Atsushi Miki; Marina Kohara; Hiromichi Yoshizawa; Takahiro Masuda; Takahisa Kobayashi; Osamu Saito; Shigeaki Muto; Daisuke Nagata

doi:10.33393/dti.2018.1400

Authors

Takuya Murakami Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Shimotsuke, Japan.
Tetsu Akimoto Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Shimotsuke, Japan.
Mari Okada Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Shimotsuke, Japan.
Erika Hishida Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Shimotsuke, Japan.
Taro Sugase Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Shimotsuke, Japan.
Atsushi Miki Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Shimotsuke, Japan.
Marina Kohara Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Shimotsuke, Japan.
Hiromichi Yoshizawa Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Shimotsuke, Japan.
Takahiro Masuda Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Shimotsuke, Japan.
Takahisa Kobayashi Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Shimotsuke, Japan.
Osamu Saito Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Shimotsuke, Japan.
Shigeaki Muto Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Shimotsuke, Japan.
Daisuke Nagata Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Shimotsuke, Japan.

DOI:

https://doi.org/10.33393/dti.2018.1400

Keywords:

Valacyclovir neurotoxicity, acute kidney injury, hemodialysis, hyponatremia, osmotic demyelination syndrome

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.