Acute kidney failure due to varicella-zoster virus solved by early antiviral treatment based on brivudin

A relation between acute kidney failure (AKF) and recent infection is well known in the medical community. Recent viral infections are rarer than bacterial infections in adults and patients. Here, we report a case of a 65-year-old woman who had a prolonged fever not responding to empiric antibiotic treatment and associated AKF characterized by oliguria, increased inflammatory markers, proteinuria, and swollen lower limbs. Tubulopathy with acute kidney injury (AKI) was diagnosed, and serial blood tests were performed together with an empiric treatment based on steroids and systemic antiviral drugs (i.e., brivudin). An increased level of immunoglobulin M (IgM) anti-varicella-zoster virus was detected. Symptoms improved with combined steroidal and antiviral treatment since clinical resolution. AKI associated with tubulopathy is rarely associated with viral infection in adults or elderly patients. Yet when clinical pictures do not offer a clear diagnosis in the early phase, acute viral infection with the identification of viral DNA/RNA or serological IgM should also be taken into account.