Encephalopathy Induced by Preventive Administration of Acyclovir in a Man with Symptomatic Multiple Myeloma and Renal Dysfunction
Kazuma Sugimoto,1 Tsuneaki Kenzaka,1,2 Ryu Sugimoto,1 Akihito Kitao,3 Hozuka Akita1 1Department of Internal Medicine, Hyogo Prefectural Tamba Medical Center, Tamba, Hyogo, Japan; 2Division of Community Medicine and Career Development, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan;...
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Dove Medical Press
2021-02-01
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| Series: | International Journal of General Medicine |
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| Online Access: | https://www.dovepress.com/encephalopathy-induced-by-preventive-administration-of-acyclovir-in-a--peer-reviewed-article-IJGM |
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| author | Sugimoto K Kenzaka T Sugimoto R Kitao A Akita H |
| author_facet | Sugimoto K Kenzaka T Sugimoto R Kitao A Akita H |
| author_sort | Sugimoto K |
| collection | DOAJ |
| description | Kazuma Sugimoto,1 Tsuneaki Kenzaka,1,2 Ryu Sugimoto,1 Akihito Kitao,3 Hozuka Akita1 1Department of Internal Medicine, Hyogo Prefectural Tamba Medical Center, Tamba, Hyogo, Japan; 2Division of Community Medicine and Career Development, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan; 3Division of Medical Oncology/Hematology, Kobe University Graduate School of Medicine, Kobe, Hyogo, JapanCorrespondence: Tsuneaki KenzakaDivision of Community Medicine and Career Development, Kobe University Graduate School of Medicine, 2-1-5, Arata-cho, Hyogo-ku, Kobe, Hyogo, 652-0032, JapanTel +81 78 382 6732Fax +81 78 382 6283Email smile.kenzaka@jichi.ac.jpBackground: Acyclovir (ACV) neurotoxicity is a neuropsychiatric condition induced by the anti-herpetic drugs ACV and valacyclovir (VACV). It is presumed that elevated blood levels of ACV and its metabolite 9-carboxymethoxymethylguanine are involved in the development of ACV-induced encephalopathy; age and renal dysfunction are risk factors. Here, we report a case of encephalopathy caused by the administration of VACV for herpes zoster prophylaxis in a patient with renal dysfunction owing to multiple myeloma.Case Presentation: Renal dysfunction was diagnosed in a 70-year-old man visiting our hospital for a medical checkup. His creatinine clearance rate was 8 mL/min. He was diagnosed with symptomatic multiple myeloma, and bortezomib/dexamethasone (BD) therapy for multiple myeloma and VACV for herpes zoster prophylaxis were initiated. We administered 500 mg/day of VACV three times a week, a lower dosage than recommended, after adjusting for his renal impairment. His renal function was monitored twice per week during therapy. During the second course of BD therapy, 6 weeks after starting treatment, he was hospitalized owing to impaired consciousness (Glasgow Coma Scale score: E2, V4, M4), and his BD and VACV therapy were suspended. Brain magnetic resonance imaging and cerebrospinal fluid analysis showed no abnormalities. Three days after discontinuing BD and VACV therapy, his consciousness recovered completely, and impaired consciousness did not recur after resuming BD therapy. His clinical diagnosis was thus ACV-induced encephalopathy.Conclusion: VACV is often prescribed to patients with multiple myeloma receiving BD therapy to prevent herpes zoster. ACV-induced encephalopathy is commonly observed in patients with renal dysfunction; especially among patients with multiple myeloma with Bence–Jones proteinuria, renal tubules are easily damaged and plasma ACV concentrations are likely to increase and induce ACV-induced encephalopathy. Careful monitoring of the level of consciousness is necessary during preventive ACV therapy in patients with renal dysfunction.Keywords: acyclovir neurotoxicity, valacyclovir, herpes zoster, Bence–Jones proteinuria |
| first_indexed | 2024-12-21T12:01:12Z |
| format | Article |
| id | doaj.art-dec24adf5fc74f2984aa67456b58ecf2 |
| institution | Directory Open Access Journal |
| issn | 1178-7074 |
| language | English |
| last_indexed | 2024-12-21T12:01:12Z |
| publishDate | 2021-02-01 |
| publisher | Dove Medical Press |
| record_format | Article |
| series | International Journal of General Medicine |
| spelling | doaj.art-dec24adf5fc74f2984aa67456b58ecf22022-12-21T19:04:49ZengDove Medical PressInternational Journal of General Medicine1178-70742021-02-01Volume 1441341761936Encephalopathy Induced by Preventive Administration of Acyclovir in a Man with Symptomatic Multiple Myeloma and Renal DysfunctionSugimoto KKenzaka TSugimoto RKitao AAkita HKazuma Sugimoto,1 Tsuneaki Kenzaka,1,2 Ryu Sugimoto,1 Akihito Kitao,3 Hozuka Akita1 1Department of Internal Medicine, Hyogo Prefectural Tamba Medical Center, Tamba, Hyogo, Japan; 2Division of Community Medicine and Career Development, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan; 3Division of Medical Oncology/Hematology, Kobe University Graduate School of Medicine, Kobe, Hyogo, JapanCorrespondence: Tsuneaki KenzakaDivision of Community Medicine and Career Development, Kobe University Graduate School of Medicine, 2-1-5, Arata-cho, Hyogo-ku, Kobe, Hyogo, 652-0032, JapanTel +81 78 382 6732Fax +81 78 382 6283Email smile.kenzaka@jichi.ac.jpBackground: Acyclovir (ACV) neurotoxicity is a neuropsychiatric condition induced by the anti-herpetic drugs ACV and valacyclovir (VACV). It is presumed that elevated blood levels of ACV and its metabolite 9-carboxymethoxymethylguanine are involved in the development of ACV-induced encephalopathy; age and renal dysfunction are risk factors. Here, we report a case of encephalopathy caused by the administration of VACV for herpes zoster prophylaxis in a patient with renal dysfunction owing to multiple myeloma.Case Presentation: Renal dysfunction was diagnosed in a 70-year-old man visiting our hospital for a medical checkup. His creatinine clearance rate was 8 mL/min. He was diagnosed with symptomatic multiple myeloma, and bortezomib/dexamethasone (BD) therapy for multiple myeloma and VACV for herpes zoster prophylaxis were initiated. We administered 500 mg/day of VACV three times a week, a lower dosage than recommended, after adjusting for his renal impairment. His renal function was monitored twice per week during therapy. During the second course of BD therapy, 6 weeks after starting treatment, he was hospitalized owing to impaired consciousness (Glasgow Coma Scale score: E2, V4, M4), and his BD and VACV therapy were suspended. Brain magnetic resonance imaging and cerebrospinal fluid analysis showed no abnormalities. Three days after discontinuing BD and VACV therapy, his consciousness recovered completely, and impaired consciousness did not recur after resuming BD therapy. His clinical diagnosis was thus ACV-induced encephalopathy.Conclusion: VACV is often prescribed to patients with multiple myeloma receiving BD therapy to prevent herpes zoster. ACV-induced encephalopathy is commonly observed in patients with renal dysfunction; especially among patients with multiple myeloma with Bence–Jones proteinuria, renal tubules are easily damaged and plasma ACV concentrations are likely to increase and induce ACV-induced encephalopathy. Careful monitoring of the level of consciousness is necessary during preventive ACV therapy in patients with renal dysfunction.Keywords: acyclovir neurotoxicity, valacyclovir, herpes zoster, Bence–Jones proteinuriahttps://www.dovepress.com/encephalopathy-induced-by-preventive-administration-of-acyclovir-in-a--peer-reviewed-article-IJGMacyclovir neurotoxicityvalacyclovirherpes zosterbence–jones proteinuria |
| spellingShingle | Sugimoto K Kenzaka T Sugimoto R Kitao A Akita H Encephalopathy Induced by Preventive Administration of Acyclovir in a Man with Symptomatic Multiple Myeloma and Renal Dysfunction International Journal of General Medicine acyclovir neurotoxicity valacyclovir herpes zoster bence–jones proteinuria |
| title | Encephalopathy Induced by Preventive Administration of Acyclovir in a Man with Symptomatic Multiple Myeloma and Renal Dysfunction |
| title_full | Encephalopathy Induced by Preventive Administration of Acyclovir in a Man with Symptomatic Multiple Myeloma and Renal Dysfunction |
| title_fullStr | Encephalopathy Induced by Preventive Administration of Acyclovir in a Man with Symptomatic Multiple Myeloma and Renal Dysfunction |
| title_full_unstemmed | Encephalopathy Induced by Preventive Administration of Acyclovir in a Man with Symptomatic Multiple Myeloma and Renal Dysfunction |
| title_short | Encephalopathy Induced by Preventive Administration of Acyclovir in a Man with Symptomatic Multiple Myeloma and Renal Dysfunction |
| title_sort | encephalopathy induced by preventive administration of acyclovir in a man with symptomatic multiple myeloma and renal dysfunction |
| topic | acyclovir neurotoxicity valacyclovir herpes zoster bence–jones proteinuria |
| url | https://www.dovepress.com/encephalopathy-induced-by-preventive-administration-of-acyclovir-in-a--peer-reviewed-article-IJGM |
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