Acyclovir-induced nephrotoxicity and neurotoxicity in a case of viral encephalitis: a case report


DERTLİ B., GÜZEL KARAHAN S., KÖSEOĞLU K., ÇAKIR A., SALDUZ E.

European Journal of Hospital Pharmacy, 2026 (SCI-Expanded, Scopus) identifier

  • Yayın Türü: Makale / Tam Makale
  • Basım Tarihi: 2026
  • Doi Numarası: 10.1136/ejhpharm-2025-004705
  • Dergi Adı: European Journal of Hospital Pharmacy
  • Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, CINAHL, EMBASE, MEDLINE
  • Anahtar Kelimeler: Acute Kidney Injury, Acyclovir, case report, DRUG-RELATED SIDE EFFECTS AND ADVERSE REACTIONS, Neuropathology
  • İnönü Üniversitesi Adresli: Evet

Özet

Viral encephalitis is a hazardous central nervous system disorder requiring immediate antiviral intervention. Acyclovir is the standard treatment for herpes simplex virus (HSV) encephalitis; nevertheless, improper dosing or administration can lead to nephrotoxicity and neurotoxicity. This case describes a 54-year-old male patient admitted for an allergic reaction, who thereafter had incoherent speech, instability and involuntary motions suggestive of HSV encephalitis. Intravenous acyclovir treatment was initiated empirically following cerebrospinal fluid examination. On the third day of therapy, the patient exhibited acute renal impairment, accompanied by hallucinations and significant psychomotor agitation. Following the clinical pharmacist’s recommendations, the dosage was adjusted and the infusion period was prolonged to at least 1hour, predicated on an estimated glomerular filtration rate of 20mL/min/1,73m². Subsequent to these surgeries, renal function and neurological status steadily enhanced, enabling a successful resolution of treatment. This example highlights the crucial role of clinical pharmacists in reducing acyclovir-related toxicities via personalised dosage and infusion management.