{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,25]],"date-time":"2026-04-25T10:00:40Z","timestamp":1777111240235,"version":"3.51.4"},"reference-count":11,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Reports"],"accepted":{"date-parts":[[2017,5,5]]},"abstract":"<jats:p>An 82-year-old man with a history of end-stage renal disease presented with progressively worsening confusion and somnolence for the past 4\u20135 days. The patient was diagnosed with herpes zoster by his primary care physician 5\u2009days ago and was started on a course of valacyclovir 1 g three times a day (dose not adjusted for renal impairment).<\/jats:p>\n               <jats:p>A lumbar puncture was performed and cerebrospinal fluid (CSF) studies revealed 37 white blood cells (WBCs)\/hpf (100% monocytes), protein 64\u2009mg\/dL and glucose 52\u2009mg\/dL. He was started on ceftriaxone, ampicillin and acyclovir. MRI of the brain was done and was unremarkable. Acyclovir-induced encephalopathy was high on differential, but his CSF findings were concerning for viral encephalitis. Nonetheless, all antimicrobials were discontinued and he was scheduled for a 5-hour dialysis session. The very next day, he showed immense improvement and eventually recovered completely. CSF PCR tests for both herpes simplex virus and varicella zoster virus came back negative.<\/jats:p>","DOI":"10.1136\/bcr-2017-220372","type":"journal-article","created":{"date-parts":[[2017,5,22]],"date-time":"2017-05-22T23:45:23Z","timestamp":1495496723000},"page":"bcr-2017-220372","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":9,"title":["A case of acyclovir neurotoxicity presenting with atypical cerebrospinal fluid findings"],"prefix":"10.1136","volume":"2017","author":[{"given":"Guramrinder Singh","family":"Thind","sequence":"first","affiliation":[{"name":"Internal Medicine, Western Michigan University School of Medicine, Kalamazoo, Michigan, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Richard","family":"Roach","sequence":"additional","affiliation":[{"name":"Internal Medicine, Western Michigan University School of Medicine, Kalamazoo, Michigan, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2017,5,22]]},"reference":[{"key":"2025082702095538000_2017.may17_1.bcr-2017-220372.1","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9343(99)00041-8"},{"key":"2025082702095538000_2017.may17_1.bcr-2017-220372.2","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1016\/S0303-8467(89)80005-8","article-title":"Listeria monocytogenes meningitis","volume":"91","author":"Peeters","year":"1989","journal-title":"Clin Neurol Neurosurg"},{"key":"2025082702095538000_2017.may17_1.bcr-2017-220372.3","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0052001","article-title":"Comparison of real time IS6110-PCR, microscopy, and culture for diagnosis of tuberculous meningitis in a cohort of adult patients in Indonesia","volume":"7","author":"Chaidir","year":"2012","journal-title":"PLoS One"},{"key":"2025082702095538000_2017.may17_1.bcr-2017-220372.4","doi-asserted-by":"crossref","unstructured":"Jacobson MA . 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