We report the case of a 69-year-old Hispanic female with end-stage renal disease (ESRD) on hemodialysis and a complex medical history who presented with acute altered mental status shortly after initiating valacyclovir at a non-renally adjusted dose. The patient was admitted to inpatient services and treated with a presumptive diagnosis of valacyclovir-associated neurotoxicity (VAN). The patient received hemodialysis for three consecutive days, resulting in neurologic improvement. Additional competing causes of altered mental status and encephalopathy were investigated and ruled out over the course of a five-day hospitalization. The patient was subsequently discharged with a diagnosis of VAN. This case underscores the importance of proper renal dose adjustment and medication safety in patients with ESRD to prevent serious, avoidable adverse drug events.
Hoang et al. (2026) studied this question.