バラシクロビルによる一過性の周期性同期性放電を伴う薬剤性脳症をきたした高齢者例  [in Japanese] Periodic synchronous discharge occurred in an elderly with acute valacyclovir-associated encephalopathy  [in Japanese]

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Author(s)

    • 中谷 光良 Nakatani Mitsuyoshi
    • 京都大学医学部医学科臨床神経学|順天堂大学医学部医学科臨床神経学 Department of Neurology, Graduate School of Medicine, Kyoto University|Department of Neurology, Graduate School of Medicine, Juntendo University
    • 池田 昭夫 Ikeda Akio
    • 京都大学医学部医学科てんかん・運動異常生理学 Department of Epilepsy, Movement Disorders and Physiology, Kyoto University

Abstract

<p>81歳女性で高血圧,サルコイドーシス,慢性腎不全で透析中の患者.右胸背部に出現した皮疹に対し帯状疱疹と診断され,バラシクロビルの内服が開始された.3日後より見当識障害,歩行障害が出現し救急搬送された.意識障害,および下肢優位の左右対称の安静時ミオクローヌスを認めた.脳波検査で周期性同期性放電(periodic synchronous discharges; PSDs)を認め,経過と所見よりバラシクロビルによる薬剤性脳症と診断した.保存的加療により意識レベルは改善し,脳波所見も軽快した.バラシクロビルはPSDsと薬剤性脳症をきたし,特に高齢者および腎機能障害患者では注意を要する.</p>

<p>An 81-year-old woman suffering from sarcoidosis, chronic renal failure caused by hypertention was treated by valacyclovir 500 mg/day, for the diagnosis of herpes zoster of her right back. Her consciousness gradually became worse, and 3 days after taking the drug, she was sent to the emergency department of the hospital. Her conscious level was E2V2M5 (Glasgow Coma Scale) and myoclonus especially in her lower extremities occurred. Head CT and MRI show no obvious, acute abnormal findings other than chronic ischemic lesions, while an electroencephalogram (EEG) shows periodic synchronous discharges (PSDs) and disorganized background activity. Based on these findings, she was diagnosed as valacyclovir-associated acute encephalopathy. After conservative therapy of maintenance hemodialysis, her consciousness gradually improved, and PSDs disappeared accordingly and background activity of EEG became improved. In this case report, we presented valacyclovir-associated neurotoxicity with PSDs in EEG as potentially a surrogate marker. We should be cautious to use valaciclovir which may cause drug-induced encephalopathy especially in elderly or patients with renal failure even though the dose was adjusted in advance.</p>

Journal

  • Rinsho Shinkeigaku

    Rinsho Shinkeigaku 56(7), 504-507, 2016

    Societas Neurologica Japonica

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