A Rare Presentation of Herpes Simplex Virus Encephalitis With Ischemic Stroke and Associated Acyclovir-Induced Acute Kidney Injury

Abstract

This case report describes a 26-year-old female presenting with clinical features of encephalitis, which progressed to ischemic stroke. In addition, she was started on intravenous acyclovir 750 mg three times a day (TID, 10 mg/kg body weight every eight hours, recommended dose), which led to the development of an acute kidney injury (AKI). Subsequently, conservative management and a reduction in the dosage of acyclovir, followed by stopping it, led to the recovery of the patient's renal function. Three days after completely stopping the drug administration, she was continued on a reduced dose of intravenous acyclovir, completing a 10-day course, with improvement in overall condition with some residual right upper limb and lower limb weakness and slurring of speech. This case signifies the importance of presentation, timely management, and prevention of acyclovir-induced AKI; in addition, it also reports a less common complication of herpes simplex virus encephalitis (HSVE), which is ischemic stroke. The management of all these herpes simplex virus (HSV-1)-related complications in a single case will add much to the existing literature.