Aciclovir
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Renal dysfunction: case report A 30-year-old woman developed renal dysfunction during treatment with aciclovir for Herpes simplex encephalitis. In January/February 2018, the woman was admitted to a hospital in Iran at 26 weeks of gestation during her second pregnancy due to neurological symptoms suspected of preeclampsia and with a GCS score of 15/15 (current presentation). Her symptoms included reduced level of consciousness, confusion, inability to answer questions, inability to recognise surrounding people, nausea, vomiting, headache on both sides of the temporal area and severe restlessness. Her history was significant for opium syrup addiction and one previous pregnancy with vaginal delivery (9 years previously). The symptoms started 2 days prior to the current presentation as nausea, vomiting and headache, which were followed by the development of severe symptoms like reduced consciousness, confusion[,] and failure to recognise surrounding people a few hours prior to the current presentation. Fetal examinations showed normal heartbeat and movements. After various examinations, preeclampsia was ruled out. Thereafter, due to mydriatic pupils, opium withdrawal syndrome was suspected. Hence, she received treatment with morphine and magnesium sulfate; however, due to persistent symptoms, a neurologist was consulted. Due to her severe neurological symptoms, she was administered haloperidol, biperiden and olanzapine. Subsequently, she developed one generalised tonic-clonic seizure, slight neck stiffness, cough and fever of 39°C, requiring transfer from obstetric unit to ICU. Examination by the neurologist, led to the suspicion of Herpes simplex encephalitis. For the confirmation of Herpes simplex encephalitis, and MRI was ordered. Prior to confirmation of Herpes simplex encephalitis by MRI, antiviral treatment was started with IV aciclovir [acyclovir] 10 mg/kg three times daily. Herpes simplex encephalitis by later confirmed by MRI. Additionally, paracetamol [acetaminophen] was started for the fever, and antibacterial treatment was started with ceftriaxone for the elimination of potential bacterial causes. During the treatment with aciclovir, her renal function was constantly monitored (by measuring urea and creatinine) due to the risk of aciclovir therapy related renal dysfunction. During the treatment, a gradual increase in her serum creatinine level was noted (reached a level of 1.4 mg/dL). Hence, the frequency of woman’s aciclovir therapy was reduced from three times daily to twice daily after 7 days of treatment, and the creatinine level improved. After MRI confirmation of Herpes simplex encephalitis, the aciclovir treatment was continued for 14 days after the diagnosis. During the hospital course, she also received potassium chloride (for hypokalaemia), diazepam (for tonic-clonic seizure), phenytoin and levetiracetam (to prevent the recurrence of seizures; administered till the time of discharge from hospital), and folic acid and ferrous sulfate (for anaemia). Her underlying condition improved after 11 da
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