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Memon W, Rose EK, Akram A, et al. A Unique Case of Valacyclovir Toxicity and Pseudobulbar Affect in a Patient On Peritoneal Dialysis. Cureus. 2021;13(2):e13494doi: 10.7759/cureus.13494.
Memon, W., Rose, E. K., Akram, A., & Simba, B. (2021). A Unique Case of Valacyclovir Toxicity and Pseudobulbar Affect in a Patient On Peritoneal Dialysis. Cureus, 13(2), e13494. https://doi.org/10.7759/cureus.13494
Memon, Waqas, et al. "A Unique Case of Valacyclovir Toxicity and Pseudobulbar Affect in a Patient On Peritoneal Dialysis." Cureus vol. 13,2 (2021): e13494. doi: https://doi.org/10.7759/cureus.13494
Memon W, Rose EK, Akram A, Simba B. A Unique Case of Valacyclovir Toxicity and Pseudobulbar Affect in a Patient On Peritoneal Dialysis. Cureus. 2021 Feb 22;13(2):e13494. doi: 10.7759/cureus.13494. PMID: 33777579; PMCID: PMC7990347.
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Cureus. 2021 Feb 22;13(2):e13494. doi: 10.7759/cureus.13494.

A Unique Case of Valacyclovir Toxicity and Pseudobulbar Affect in a Patient On Peritoneal Dialysis.

Cureus

Waqas Memon, Emily K Rose, Ayesha Akram, Brian Simba

Affiliations

  1. Internal Medicine/Nephrology, Virginia Commonwealth University, Richmond, USA.
  2. Internal Medicine, Virginia Commonwealth University, Richmond, USA.
  3. Internal Medicine, Combined Military Hospital, Rawalpindi, PAK.
  4. Internal Medicine, Rawalpindi Medical University, Rawalpindi, PAK.

PMID: 33777579 PMCID: PMC7990347 DOI: 10.7759/cureus.13494

Abstract

There are a few cases of valacyclovir-associated neurotoxicity (VAN) reported. This case report documents a case of a 55-year-old male presenting with emotional lability or pseudobulbar affect as the predominant or sole manifestation of VAN. A failure to adjust valacyclovir's dose for herpes simplex infection in the setting of dialysis-dependent end-stage renal disease (ESRD) preceded VAN in this patient. The patient presented with involuntary and uncontrollable outbursts of emotion. Computerized tomography (CT) scan identified no underlying cause. A complete neurological examination with cognitive assessment was performed, with no abnormalities. He benefited from the use of aggressive peritoneal dialysis (PD) that was employed to enhance valacyclovir's clearance in this case of intractable VAN. On discharge, the patient was back to baseline mental function. Traumatic brain injury, neoplasm, vascular lesions, metabolic abnormality, neurological disease, herpetic encephalitis, and disorders of mood were ruled out. This led to the hypothesis of encephalopathy due to valacyclovir intoxication. Given that the clinical manifestations were related to ESRD, a dose-adjustment of valacyclovir is imperative in the setting of ESRD to prevent VAN. Our case presents important clinical variations. Firstly, our patient demonstrates that VAN may present with no focal neurological impairment, but pseudobulbar affect. Secondly, aggressive PD was useful in this case for the treatment of VAN as opposed to hemodialysis. We believe that it cleared valacyclovir resulting in the resolution of symptoms.

Copyright © 2021, Memon et al.

Keywords: end stage renal disease (esrd); peritoneal dialysis (pd); pseudobulbar affect; valacyclovir-induced neurotoxicity

Conflict of interest statement

The authors have declared that no competing interests exist.

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