Severe mental disorders following anti-retroviral treatment in a patient on peritoneal dialysis: A case report and literature review

Table 1 The reported cases of acyclovir/valacyclovir neurotoxicity in the literature

Author	Year of publication	Patient	Stage of CKD	Renal replacement manner	Dosage (mg/d)	Duration of antiviral treatment	Concomitant medication	Neuropsychiatric symptoms	Outcome
		sex/age
Pipili et al[18]	2013	Female/72	ESRD	PD	Valacyclovir tablets 3 g daily for 3 d	3 d	Nifedipine, irbesartan, cinacalcet, atorvastatin, alfacalcidol	Confusion and visual hallucinations	3 d, restored after PD 6 × 2 L per day
Chaudhari et al[16]	2014	Male/66	ESRD	PD	Oral valacyclovir 1000 mg daily for 7 d	7 d	Simvastatin, metoprolol, sevelamer, furosemide, and glimepiride	Hallucination, insomnia, and photosensi-tivity	7 d, improved after regular regimen and hydration
Asahi et al[17]	2009	Female/78	Without previous renal failure	NO	Valacyclovir 3000 mg/d	6 d	Not mentioned	Unconsciou-sness	5 d, recovered 14 d later
Asahi et al[17]	2009	Male/73	ESRD	Hemodialysis	Valacyclovir 3000 mg/d	2 d	Not mentioned	Confusion, hallucination	2 d, completely recovered 3 d later
Singh et al[19]	2014	Female/58	ESRD	HD	Valacyclovir 500 mg/d	2 d	Not mentioned	Altered sensorium, irritability, drowsiness, confusion	2 d, completely recovered 5 d later
Kambham-pati et al[20]	2011	Female/49	ESRD	Maintenance hemodialysis	Valacyclovir 1000 mg three times a day	2 d	Not mentioned	Disoriented, confused, agitated, hallucinating, delirious, incoherent	1 d, 4000 mg, completely recovered after second session of hemodialysis
Prasad et al[14]	2017	Female/57	ESRD	PD	1000 mg three times per day of valacyclovir	3 d	Not mentioned	Confusion and altered sensorium	1 day, completely recovered 24 h later
Izzedine et al[21]	2001	Female/60	ESRD	PD	Valacyclovir 500 mg daily	Reduced 500 mg of valacyclovir every 2 d	Not mentioned	Disorientated with ocular and auditory hallucinations and loss of decorum without torpor or coma.	3 d, recovered 48 h later
Strumia et al[22]	2004	Male/81	ESRD	Hemodialysis	Oral valacyclovir 1000 mg every 8 h then intravenous acyclovir in full dosage	3 d	Not mentioned	Visual hallucination, confusion and disorientation	3 daysd completely recovered 6 d later
Linssen-Schuurmans et al[23]	1998	Male/58	CKD	Intermittent hemodialysis twice a week	Valacyclovir 3 g/d	2 d	Not mentioned	Dizziness, hallucinations, loss of decorum, disoriented, slurred speech	1 d, complete recovery
Takayanagi et al[24]	2010	Male/67	ESRD	PD	Valacyclovir, 1 g/d	5 d	Not mentioned	Hallucina-tions	7 d, complete recovery
Sadjadi et al[25]	2018	Male/80	ESRD	PD	Acyclovir 5 mg/kg intravenously, followed by oral acyclobir 400 mg/d	3 d	Not mentioned	Confusion, delusion, disorientation, restlessness, visual hallucinations, seizures	2 d, complete recovery

CKD: Chronic kidney disease; ESRD: End-stage renal disease; PD: Peritoneal dialysis.