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Acyclovir‐Induced Immune Thrombocytopenia in a Patient with Herpes Zoster of the Trigeminal Nerve
Author(s) -
Katsenos Stamatis,
Gkolias Dimitrios,
Nikolopoulou Melita
Publication year - 2010
Publication title -
pharmacotherapy: the journal of human pharmacology and drug therapy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.227
H-Index - 109
eISSN - 1875-9114
pISSN - 0277-0008
DOI - 10.1592/phco.30.10.1085
Subject(s) - medicine , adverse effect , shingles , dermatology , trigeminal nerve , aciclovir , immune system , immunology , surgery , herpesviridae , virus , viral disease
Acyclovir has been widely used as an antiviral agent for the treatment of infections caused by herpes simplex and varicella‐zoster viruses. The drug is usually well tolerated; however, rarely, adverse effects may be severe, including neuropsychiatric reactions, gastrointestinal disturbances, skin lesions, renal disorders, and dyscrasias. We describe a 20–year‐old man who was treated with intravenous acyclovir 5 mg/kg every 8 hours for a herpes zoster infection (shingles) that involved painful vesicular lesions and skin eruptions along the third branch of trigeminal nerve. Despite favorable improvement of his cutaneous lesions, the patient developed severe thrombocytopenia within 5 days of starting acyclovir. The drug was discontinued, and the patient's condition improved by using a supportive therapeutic approach. An extensive workup for detection of acyclovir‐dependent platelet antibodies indicated positive results, implicating acyclovir as a cause of thrombocytopenia. In addition, the temporal relationship between the start of acyclovir and the onset of thrombocytopenia, along with the exclusion of the other most frequently occurring known causes of thrombocytopenia, established a definitive diagnosis of acyclovir‐induced immune thrombocytopenia. To our knowledge, this is the first well‐documented report of isolated severe immune thrombocytopenia induced by acyclovir. Clinicians should be aware of this rare potential adverse reaction, as prompt diagnosis is the cornerstone of appropriate management.