Confusion and agitation after a recent kidney transplantation

A 51-year-old man, who received a living related transplant from his wife and anti-thymocyte globulin (ATG) as induction therapy, developed delayed graft function after transplantation. One day after he received an i.v. dose of ganciclovir, the patient developed hallucinations, confusion and agitation, which worsened the following day. CT­scan of the brain and cerebrospinal fluid were unremarkable. Ganciclovir-induced encepha­lopathy was considered the most likely reason for the patient's neurological condition, since he recovered completely a few days after discontinuation of this drug. Since anti-CMV prophylactic treatment is now widely used after transplantation, a high index of suspicion is required to diagnose ganciclovir (or acyclovir) induced neurotoxicity.