valacyclovir and Diarrhea

A 73-year-old man presented to our hospital with a sore throat (left-sided) and hiccups. The patient had mucosal swelling and erosions affecting the left posterior pillar, base of tongue, epiglottis, arytenoid, and aryepiglottic fold. As the laryngeal mucosal edema became worse, herpetic vesicles and erosions developed on the left cavum conchae, external auditory canal, and palate. The patient was treated with acyclovir and a steroid. His hiccups were treated with metoclopramide, but it had little effect, and hiccups only subsided gradually after the disappearance of erosions. His hiccups relapsed transiently with vomiting, and then resolved completely. Elevation of the CF titer after 2 weeks confirmed the diagnosis of herpes zoster. This condition should be considered in patients with unilateral sore throat and intractable hiccups, and treatment with acyclovir should be provided.

Topics: Acyclovir; Administration, Oral; Aged; Anti-Inflammatory Agents; Antiviral Agents; Diarrhea; Edema; Herpes Zoster; Hiccup; Humans; Hydrocortisone; Infusions, Intravenous; Laryngeal Mucosa; Laryngitis; Male; Metoclopramide; Retreatment; Valacyclovir; Valine

To report a case of Clostridium difficile colitis associated with valaciclovir treatment.. A 73-year-old man with lumbar herpes-zoster started valaciclovir 1 g tid. After three days he began vomiting and developed diarrhea, three to four stools per day. Symptoms worsened over the following days and he was admitted. Valaciclovir was stopped and fluid and electrolyte replacement was started. He continued 6 days later with diarrhea of 7 to 13 stools per day and a stool test for diagnosis of C. difficile infection was performed with a positive result. The patient received oral metronidazole (500 mg/t.i.d. for 10 days) and rapid improvement and eventual resolution of his diarrhea was observed after 3 days of therapy.. Although no conclusive reports of this reaction exist, we think this is a case of C difficile colitis that appeared three days after valaciclovir was initiated. Colitis improved with metronidazole. Other causes of diarrhea were excluded, such as diabetes mellitus, renal failure, intestinal surgery and intestinal obstruction. Infection was confirmed by a positive test for C. difficile. The application of Naranjo's algorithm asserts the reaction as 'probable'.. Valaciclovir-associated C. difficile colitis, although rare, can have severe consequences for the patient's health. It should be included as a possible adverse effect of valaciclovir treatment by health professionals.

Topics: Acyclovir; Aged; Antiviral Agents; Clostridioides difficile; Diarrhea; Enterocolitis, Pseudomembranous; Herpes Zoster; Humans; Male; Valacyclovir; Valine

The main non-HIV presentations at the 1995 Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC) are reviewed. Issues addressed vancomycin resistance, the use of antibiotics in overcoming drug resistance, two new classes of antibiotics that are active against resistant gram-positive bacteria, hepatitis A screening for low-risk prospective travelers to developing countries, a new antiviral agent (valaciclovir) for use against genital herpes, amphotericin B lipid therapy for invasive candidiasis, and cryptosporidium as a major cause of severe diarrhea.

Topics: Acyclovir; Amphotericin B; Anti-Bacterial Agents; Antifungal Agents; Antiviral Agents; Candidiasis; Cryptosporidium; Diarrhea; Drug Carriers; Drug Resistance, Microbial; Gram-Positive Bacteria; Hepatitis A; Herpes Genitalis; Valacyclovir; Valine; Vancomycin