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<p>The patient was a 64-year-old woman who was undergoing maintenance hemodialysis for end-stage renal disease caused by diabetic nephropathy. She developed herpes zoster in the first branch of the left trigeminal nerve and was initially treated with amenamevir (AMNV). However, she subsequently developed aseptic meningitis. After switching from AMNV to acyclovir (ACV), her symptoms, including fever and nausea, improved rapidly. AMNV is metabolized in the liver and excreted in feces, making it a suitable antiviral agent for patients with renal impairment. There are limited reports on the use of AMNV in dialysis patients, but several studies have reported its safety, and once-daily administration appears to improve medication adherence in these patients. Unlike ACV, AMNV does not pose concerns regarding concentration-dependent side effects. However, recent cases of varicella-zoster virus-induced meningitis during AMNV therapy have been reported. This may be attributable to the limited penetration of AMNV into the cerebrospinal fluid. In elderly individuals, immunocompromised patients, and those with herpes zoster involving the trigeminal nerve region, the risk of central nervous system complications is increased. This is the first case report of aseptic meningitis developing during AMNV treatment for herpes zoster in a dialysis patient. When AMNV is considered for the treatment of herpes zoster, careful evaluation of the lesion location and risk factors for serious complications is warranted to ensure appropriate use.</p>

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A case of aseptic meningitis in a dialysis patient despite treatment with amenamevir for herpes zoster

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  • 发表日期：

    2025年9月6日

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  • Akinori Watanabe,
  • Shinichiro Tsunoda,
  • Kenta Tanaka,
  • Keishiro Fujimoto,
  • Takehito Harimoto,
  • Nao Ikeda,
  • Daihi Sato,
  • Yotaro Takami,
  • Yuri Shimada,
  • Atsuyuki Morishima,
  • Katsuhiko Sakaguchi

摘要

The patient was a 64-year-old woman who was undergoing maintenance hemodialysis for end-stage renal disease caused by diabetic nephropathy. She developed herpes zoster in the first branch of the left trigeminal nerve and was initially treated with amenamevir (AMNV). However, she subsequently developed aseptic meningitis. After switching from AMNV to acyclovir (ACV), her symptoms, including fever and nausea, improved rapidly. AMNV is metabolized in the liver and excreted in feces, making it a suitable antiviral agent for patients with renal impairment. There are limited reports on the use of AMNV in dialysis patients, but several studies have reported its safety, and once-daily administration appears to improve medication adherence in these patients. Unlike ACV, AMNV does not pose concerns regarding concentration-dependent side effects. However, recent cases of varicella-zoster virus-induced meningitis during AMNV therapy have been reported. This may be attributable to the limited penetration of AMNV into the cerebrospinal fluid. In elderly individuals, immunocompromised patients, and those with herpes zoster involving the trigeminal nerve region, the risk of central nervous system complications is increased. This is the first case report of aseptic meningitis developing during AMNV treatment for herpes zoster in a dialysis patient. When AMNV is considered for the treatment of herpes zoster, careful evaluation of the lesion location and risk factors for serious complications is warranted to ensure appropriate use.