Abstract
The herpes simplex virus type 2 (HSV-2) is a common pathogen that typically presents asymptomatically or causes mild mucocutaneous infections. Following primary infection, it establishes latency in the ganglia and can later reactivate, leading to severe infections at other sites, such as the central nervous system (CNS). These infections are treated with acyclovir, a DNA polymerase inhibitor that, in its intravenous form, achieves adequate cerebrospinal fluid (CSF) concentrations. However, it may cause neurotoxicity and nephrotoxicity. We present a case of HSV-2 meningitis in a patient who developed neurotoxicity and nephrotoxicity due to acyclovir. Both resolved after switching to famciclovir, highlighting the need for further studies to assess the safety and efficacy of this antiviral in this context.
References
Zhu S, Viejo-Borbolla A. Pathogenesis and virulence of herpes simplex virus. Virulence [Internet]. [citado 23 de noviembre de 2024];12(1):2670-702. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8923070/. DOI: 10.1080/21505594.2021.1982373
Gundamraj S, Hasbun R. The Use of Adjunctive Steroids in Central Nervous Infections. Front Cell Infect Microbiol. 2020;10:592017. DOI: 10.1097/QCO.0000000000000922
Rozenberg F. Virus herpes simplex et infections du systeme nerveux central: encephalite, meningite, myelite. Virologie [Internet]. 1 de septiembre de 2020 [citado 23 de noviembre de 2024];24(5):283-94. Disponible en: https://www.jle.com/fr/revues/vir/e-docs/virus_herpes_simplex_et_infections_du_systeme_nerve ux_central_encephalite_meningite_myelite_318783/article.p html?tab=texte. DOI: 10.1684/vir.2020.0862
J. Mensa. Guía de terapéutica antimicrobiana. 34a ed. Barcelona.
Fang R, Zhou Y, Han L, Chen W, Guan N, Li J. Pharmacovigilance study of famciclovir in the Food and Drug administration adverse event reporting system database. Sci Rep. 19 de noviembre de 2024;14(1):28637. DOI: 10.1038/s41598-024-80236-1
Sadowski LA, Upadhyay R, Greeley ZW, Margulies BJ. Current Drugs to Treat Infections with Herpes Simplex Viruses-1 and -2. Viruses [Internet]. julio de 2021 [citado 24 de noviembre de 2024];13(7):1228. Disponible en: https://www.mdpi.com/1999-4915/13/7/1228. DOI: 10.3390/v13071228
Cunha BA, Baron J. The pharmacokinetic basis of oral valacyclovir treatment of herpes simplex virus (HSV) or varicella zoster virus (VZV) meningitis, meningoencephalitis or encephalitis in adults. J Chemother [Internet]. 4 de marzo de 2017 [citado 26 de noviembre de 2024];29(2):122-5. DOI: 10.1179/1973947815Y.0000000065
Tunkel AR, Glaser CA, Bloch KC, Sejvar JJ, Marra CM, Roos KL, et al. The Management of Encephalitis: Clinical Practice Guidelines by the Infectious Diseases Society of America. Clin Infect Dis [Internet]. 1 de agosto de 2008 [citado 26 de noviembre de 2024];47(3):303-27. DOI: 10.1086/589747
Coscojuela Otto A, Peña Porta JM, Álvarez Lipe R. Fracaso renal agudo secundario a aciclovir. Med Clínica [Internet]. 10 de enero de 2020 [citado 24 de noviembre de 2024];154(1):36. Disponible en: https://www.sciencedirect.com/science/article/pii/S00257753 19302933. DOI: 10.1016/j.medcli.2019.03.031
Xu R, Gao Q, Zhang Y, Lin Y, Li Y, Su L, et al. Associations between Different Antivirals and Hospital-Acquired Acute Kidney Injury in Adults with Herpes Zoster. Clin J Am Soc Nephrol [Internet]. junio de 2024 [citado 24 de noviembre de 2024];19(6):694. Disponible en: https://journals.lww.com/cjasn/abstract/2024/06000/associati ons_between_different_antivirals_and.5.aspx.DOI:10.2215/C JN.0000000000000452
Vonberg FW, Dawson A, Scott G, Davies N. Aciclovir-induced neurotoxicity. Pract Neurol. abril de 2023;23(2):157-9. DOI: 10.1136/pn-2022-003597
Olar P, Garg AX, Weir MA, Ahmadi F, McArthur E, Lam NN, et al. Higher dose antiviral therapy for herpes infections is associated with a risk of serious adverse events in older adults with chronic kidney disease. Pharmacol Res Perspect [Internet]. 20 de octubre de 2024 [citado 24 de noviembre de 2024];12(6):e70028. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11491552/. DOI: 10.1002/prp2.70028
Yoon H, Rhew KY. Famciclovir as an antiviral agent for a patient with acute renal failure. Int J Clin Pharm [Internet]. 1 de abril de 2013 [citado 24 de noviembre de 2024];35(2):173-5. Disponible en: https://link.springer.com/article/10.1007/s11096-012-9737-9. DOI: 10.1007/s11096-012-9737-9
Htwe TH, Bergman S, Koirala J. Famciclovir substitution for patients with acyclovir-associated renal toxicity. J Infect. septiembre de 2008;57(3):266-8. DOI: 10.1016/j.jinf.2008.06.008

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Copyright (c) 2025 Sara Miguel-Álvarez; Virginia Víctor-Palomares (Revisor IPAO); Juncal Pérez-Somarriba; Vicente Estrada-Pérez (Revisor IPAO)