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Shingles on Anti-CD20 – Antiviral Treatment — SCE Neurology MCQ

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HardCNS InfectionsShingles on Anti-CD20 – Antiviral TreatmentSCE Neurology

A 48-year-old receiving ocrelizumab for multiple sclerosis develops disseminated vesicular lesions in several dermatomes with headache and lymphocytic CSF. Renal function is normal. Which initial antiviral prescription is most appropriate while VZV PCR is pending?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: E — Aciclovir 10 mg/kg intravenously every 8 hours, infused over 1 hour

Explanation lettering: B = shown as A · C = shown as B · E = shown as C · A = shown as D · D = shown as E

A and B are oral regimens inadequate for suspected CNS/disseminated disease in an immunocompromised patient. C is not first-line for VZV and the proposed frequency is not a treatment regimen. D is correct: the IV aciclovir SmPC specifies 10 mg/kg every 8 hours for immunocompromised VZV infection, with renal adjustment and one-hour infusion. E underdoses a patient with normal renal function.

Reference: Aciclovir intravenous infusion: Summary of Product Characteristics: https://www.medicines.org.uk/emc/product/6175/smpc ABN/BIA guideline: management of suspected viral encephalitis in adults: https://encephalitis.info/wp-content/uploads/2023/11/Management-of-Viral-Encephalitis-in-Adults.pdf