Reactions 1959, p24 - 3 Jun 2023 1

Aciclovir/lactulose/rifaximin S

Lack of efficacy: case report

A 24-year-old woman exhibited lack of efficacy during treatment with aciclovir, lactulose and rifaximin for multiple indications
[routes and dosages not stated].
The woman at 23 weeks of gestation presented to a facility with complaints of fevers and fatigue. Later, she was discharged with
symptomatic treatment. Two weeks later, she developed encephalopathy, profound liver failure and thrombocytopenia. Thereafter,
she underwent induction of labour and loss of the infant. After that she was intubated and developed shock requiring unspecified
pressors. She was placed on molecular adsorbent recirculating system (MARS) dialysis. Later, she was tested positive for herpes
simplex virus-1 (HSV-1) infection. Then, she started receiving aciclovir [acyclovir] along with supportive therapy. Thereafter,
improvement was noted on MARS. Later, she was extubated. However, on following days later, she returned to the baseline. Also,
she developed jaundice, ascites significant for spontaneous bacterial peritonitis and encephalopathy. Then, she started receiving
symptomatic treatment with lactulose and rifaximin for bacterial peritonitis and encephalopathy. However, she was noted refractory
to lactulose and rifaximin (lack of efficacy). Despite receiving aciclovir, rifaximin and prior MARS therapy, her liver enzymes
increased (lack of efficacy). Later, she was reintubated. Eventually, she died due to multiorgan failure and disseminated HSV-1.
Lopez D, et al. A Fatal Case of Herpes Simplex Hepatitis in Pregnancy. American Journal of Gastroenterology 117 (Suppl. 2): S2075, No. 10, Oct 2022. Available from:
URL: http://doi.org/10.14309/01.ajg.0000869668.04454.44 [abstract] 803787438

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