Herpes zoster encephalitis in two patients with kidney disease: Diagnostic and therapeutic challenges
06 Aug 2025
byDr. Gordon Chun-Kau Chan, Specialist in Nephrology, Hong Kong
Case 1: A 73-year-old woman with diabetes and end-stage renal disease receiving acyclovir treatment for herpes zoster (HZ) presented with altered mental status. Laboratory tests and brain CT were unremarkable. What is the diagnosis? Acyclovir neurotoxicity or HZ encephalitis?
Case 2: A 63-year-old man with sudden onset of rapidly progressive glomerulonephritis presented with severe acute confusion 1 month after initiation of high-dose immunosuppressants and corticosteroid. Physical examination found HZ vesicles at L1 dermatomes and lumbar puncture confirmed HZ encephalitis. Treatment dilemma: To continue immunosuppressive therapy to save the kidney, or taper off to save the brain and cognition?