Impact of continuous hemodiafiltration on serum acyclovir concentrations in a patient with encephalopathy

IF 1.7 4区医学 Q3 INFECTIOUS DISEASES

Journal of Infection and Chemotherapy Pub Date : 2025-12-01 Epub Date: 2025-11-10 DOI:10.1016/j.jiac.2025.102859

Takahiro Ito , Kotaro Itohara , Sachi Hirata , Takeshi Kimura , Yumi Kitahiro , Tomohiro Omura , Joji Kotani , Ikuko Yano

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引用次数: 0

Abstract

Reports on serum acyclovir (ACV) concentrations in patients undergoing continuous hemodiafiltration (CHDF) remain limited. We present a case describing the impact of CHDF on serum ACV levels in a patient with encephalopathy. A Japanese woman in her 70s was prescribed oral valacyclovir (VACV) at a dose of 1000 mg three times daily for herpes zoster ophthalmicus. After 7 days of treatment, she was admitted to a local hospital with fever, dysarthria, altered consciousness, hallucinations, and headache. Her serum creatinine level was elevated at 4.02 mg/dL. Intravenous ACV was initiated under the clinical suspicion of varicella zoster virus (VZV) encephalitis. However, after 3 days of treatment without improvement in consciousness, she was transferred to our hospital. Her serum ACV concentration upon admission was 14.1 μg/mL. Suspecting ACV-induced encephalopathy and renal dysfunction, CHDF was promptly initiated. Following CHDF therapy, serum ACV levels declined rapidly, accompanied by a gradual improvement in consciousness. This case suggests that CHDF may be an effective therapeutic option for managing ACV-associated nephropathy and encephalopathy.

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持续血液滤过对脑病患者血清无环鸟苷浓度的影响。

关于持续血液滤过（CHDF）患者血清无环鸟苷（ACV）浓度的报道仍然有限。我们提出一个病例，描述CHDF对脑病患者血清ACV水平的影响。一名70多岁的日本妇女每天三次口服1000毫克的伐昔洛韦（VACV）治疗带状疱疹。治疗7天后，患者因发热、构音障碍、意识改变、幻觉和头痛入住当地医院。血清肌酐升高至4.02 mg/dL。临床怀疑为水痘带状疱疹病毒（VZV）脑炎，开始静脉注射ACV。治疗3天后，患者意识未见好转，转至我院。入院时血清ACV浓度为14.1 μg/mL。怀疑acv引起的脑病和肾功能障碍，CHDF立即开始。CHDF治疗后，血清ACV水平迅速下降，并伴有意识逐渐改善。本病例提示CHDF可能是治疗acv相关肾病和脑病的有效选择。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Infection and Chemotherapy INFECTIOUS DISEASES-PHARMACOLOGY & PHARMACY

CiteScore

4.10

自引率

4.50%

发文量

303

审稿时长

47 days

期刊介绍： The Journal of Infection and Chemotherapy (JIC) — official journal of the Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases — welcomes original papers, laboratory or clinical, as well as case reports, notes, committee reports, surveillance and guidelines from all parts of the world on all aspects of chemotherapy, covering the pathogenesis, diagnosis, treatment, and control of infection, including treatment with anticancer drugs. Experimental studies on animal models and pharmacokinetics, and reports on epidemiology and clinical trials are particularly welcome.