Successful Treatment of Varicella Zoster Encephalitis in a Sarcopenic Obese Patient after Acyclovir-induced Acute Kidney Injury: The Necessity of Individualized Dosing.

Acyclovir (ACV) is the first-line agent for varicella zoster virus (VZV) encephalitis. Acute kidney injury (AKI) remains a clinical concern. We report the case of a sarcopenic obese woman with VZV encephalitis. She developed AKI 2 days after receiving intravenous ACV based on her actual body weight. After temporarily discontinuing ACV and confirming recovery of the renal function, ACV was restarted at a dose based on her ideal body weight. The patient recovered without any further complications. This case underscores the importance of dose adjustment of water-soluble medications, such as ACV, in obese patients, particularly in those with sarcopenic obesity.