Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 26, 2019; 7(20): 3329-3334
Published online Oct 26, 2019. doi: 10.12998/wjcc.v7.i20.3329
Severe mental disorders following anti-retroviral treatment in a patient on peritoneal dialysis: A case report and literature review
Qi-En He, Min Xia, Guang-Hui Ying, Xue-Lin He, Jiang-Hua Chen, Yi Yang
Qi-En He, Xue-Lin He, Jiang-Hua Chen, Yi Yang, Kidney Disease Center, the First Affiliated Hospital, College of Medicine, Zhejiang University, Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang Province, the Third Grade Laboratory Under the National State, Administration of Traditional Chinese Medicine, Hangzhou 310000, Zhejiang Province, China
Qi-En He, Min Xia, Guang-Hui Ying, Xue-Lin He, Department of Nephrology, Beilun People's Hospital, Ningbo 315000, Zhejiang Province, China
Author contributions: Yang Y performed the investigation and provided resources for the case care and report; Xia M, Ying GH collected the patient’s clinical data; He XL analyzed data; He QE wrote the first draft of the article; Chen JH and Yang Y reviewed and edited the article for important intellectual content.
Supported by the grant from the National Nature Science Foundation of China, No. 81670621; and the Nature Science Foundation of Zhejiang Province, No. LY16H050001.
Informed consent statement: Consent was obtained from relatives of the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Yi Yang, MD, Doctor, Kidney Disease Center, the First Affiliated Hospital, College of Medicine, Zhejiang University, Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang Province; the Third Grade Laboratory under the National State, Administration of Traditional Chinese Medicine, Hangzhou 310000, Zhejiang Province, China. zjukidney@zju.edu.cn
Telephone: +86-571-87236992
Received: May 29, 2019
Peer-review started: June 4, 2019
First decision: August 1, 2019
Revised: August 23, 2019
Accepted: September 11, 2019
Article in press: September 11, 2019
Published online: October 26, 2019
Processing time: 150 Days and 20 Hours
Abstract
BACKGROUND

Antiviral drugs are widely used in populations with viral infection caused by immunologic inadequacy. Because these drugs are mainly metabolized by the kidneys, patients with renal failure undergoing renal replacement therapy are prone to drug adverse effects and poisoning. Severe neurotoxicity caused by antiviral drugs is a rare but life-threatening complication.

CASE SUMMARY

This study reported one male patient on peritoneal dialysis who suffered from severe mental disorders after receiving an overdose of acyclovir and valacyclovir for the treatment of herpes zoster. The literature review suggested that hemodialysis is better than peritoneal dialysis to clear acyclovir from the circulation. The patient died after his consciousness deteriorated despite peritoneal dialysis and continuous blood purification.

CONCLUSION

This case emphasizes cautiousness when using anti-retroviral drugs in patients with uremia. Hemodialysis is optimal method to remove the drugs.

Keywords: Chronic renal failure; Peritoneal dialysis; Acyclovir; Valacyclovir; Neurotoxicity; Herpes zoster; Case report

Core tip: A patient on peritoneal dialysis who received an overdose of anti-virals showed severe mental disorders. Peritoneal dialysis and continuous renal replacement therapy did not improve the symptoms. Hemodialysis is recommended to remove excess drugs.