Navigating herpes zoster and acyclovir-induced acute kidney injury in pregnancy: a case report

Acyclovir, despite its favourable safety profile, has been observed to cause nephrotoxicity associated with its administration. We report a case involving a 31-year-old woman who was pregnant at six weeks gestation, presented with a 5-day duration of painful, non-pruritic rashes on the abdomen, back, and upper thigh. Examination revealed multiple painful vesicles with an erythematous base distributed along the right T9, L2, and L3 dermatomes. Initial blood investigations, including renal profile, were unremarkable. A diagnosis of multi-dermatomal herpes zoster was made, and intravenous acyclovir was initiated. Subsequently, the patient developed acute kidney injury, characterized by elevated serum creatinine levels, suspected to be due to crystal-induced nephropathy, a known adverse effect of acyclovir. Aggressive intravenous hydration was initiated, and acyclovir was discontinued, leading to gradual improvement in renal function and recovery. This report highlights the importance of early recognition and prompt intervention in managing acyclovir-induced nephrotoxicity during pregnancy.