Fatal Vidarabine Toxicity in a Patient With Normal Renal Function

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Abstract
PATIENTS experiencing disseminated varicella-zoster infection may have significant morbidity in the form of pain, extreme fevers (temperature ≥40 °C), rigors, anorexia, malaise, and, rarely, pneumonia, hepatitis, and encephalitis.1Initially, vidarabine sodium phosphate showed promising results in disseminated herpes zoster with a very low incidence of clinical toxicity.2More recently, however, several authors have reported cases of possible neurological toxicity. This toxicity was manifested by tremors, dysarthria, confusion, coma, or a combination.3-5Death occurred in several patients.6Except for one patient with evidence of renal insufficiency, symptoms developed during administration of the drug. We have recently observed a patient with disseminated varicella-zoster infection in whom severe, ultimately fatal, CNS symptoms developed 48 hours after completion of an initial three-day course of vidarabine. We report the details of this case of apparent vidarabine CNS toxicity that occurred in the presence of normal renal function in a patient with

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