Confusion in Patients with Shingles and Renal Failure: Acyclovir Neurotoxicity or Herpes Encephalitis

Abstract

It is not uncommon for patients with shingles and renal failure who develop confusion during the course of therapy. The patient may have suffered from the adverse reaction of acyclovir or have the neurologic complication related to the dermatological herpes zoster. Acyclovir induced neurotoxicity and herpes encephalitis have similar clinical feature but their treatments are completely different. Often, doctors face challenges in differentiating the two conditions and the dilemma of whether to continue or stop acyclovir. We reported two cases of renal impairment patient who developed altered mental state after receiving oral acyclovir for the herpes skin lesion. One suffered from varicella encephalitis and the other had acyclovir-induced neurotoxicity. The difference in clinical features among the two conditions and the management of acyclovir-induced neurotoxicity was highlighted.