Acyclovir induced nephropathy in an encephalitis patient: a case report and review of literature 

SUBJECT OBJECTIVE: Acyclovir is an antiviral drug used in herpes and varicella infections causing Encephalitis. Serious adverse events in patients treated with Acyclovir are rare. Hereby, we report a case of an Egyptian patient, treated with Acyclovir for viral Encephalitis, who developed Nephropathy. METHOD: A 35‐year‐old male was admitted to the hospital with fever refractory to antipyretic medications. Although the patient was drowsy and inattentive, with progressive decline in conscious level, the MRI Brain reveled no signs of Encephalitis. However, Laboratory results showed: ﴾1﴿ CSF analysis: an increase in CSF proteins and CSF cells to 400 cells/mm3, ﴾2﴿ CBC: increase in total leucocyte count to 17.41 thousand/cmm, ﴾3﴿ CSF culture showed no evidence of bacterial infection, and ﴾4﴿ normal renal functions tests. A diagnosis of viral encephalitis was reached. Acyclovir intravenous injection 750 mg /8 hours was given and the patient kept under monitoring. After 3 days on Acyclovir treatment, renal function tests increased suddenly ﴾Creatinine level 6.9 mg/dl﴿ with progressive deterioration in the conscious level. RESULTS: Renal function tests improved gradually with adjustment of intravenous acyclovir to 750 mg/24 hours and the patient consciousness returned to normal. CONCLUSION: The present case showed that high‐dose intravenous Acyclovir might induce nephropathy due to direct renal tubular toxicity, acute interstitial nephritis, and crystal nephropathy. High dose intravenous acyclovir should be prescribed with caution for patients with viral Encephalitis. FUNDING: This research received no specific grant from any funding agency in the public, commercial, or not‐for‐profit sectors.