We report two cases of herpes zoster with the complicatin of liver dysfunction following intravenous administration of acyclovir.
The first case is a 44-year-ol d female, with herpes zoster on the right Th4 dermatome, who was admitted to our hospital for treatment with intravenous acyclovir, 500mg daily for 5 days, and continuous epidural block with bupivacaine. The herpetic pain disappeared quickly. However, general malaise and fever developed on the 22nd days after the start of treatment. Laboratory examination showed elevated serum GOT (269IU/l), GPT (503IU/l), and eosinophilia (12.5%), which returned to normal 4 weeks later.
The second case is a 57-year-old male, with herpes zoster of the right L3 dermatome, who was also admitted and treated with the same regimen as the first case. General malaise and fever developed on the 18th day. Laboratory examination showed elevated serum GOT (362IU/l), GPT (672IU/l), and eosinophilia (15.0%), which returned to normal 7 weeks later. In both patients, hepatitis A-IgM antibody, hepatitis B-surface antigen or antibodies to hepatitis C were not detected.
Elevated transaminases, fever, and eosinophilia, found in both cases strongly suggested that the dysfunction of the liver was caused by hypersensitivity reaction to acyclovir.