VCOM Carolinas Research Day 2023

Clinical Case-Based Reports

Treatment of Long-Haul Covid Patients with Off Label Acyclovir

Emily German, OMS III, Meera Jairath, OMS III, John Caston, MD. Upstate Psychiatric Associates, Psychiatry, Spartanburg, SC.

Abstract # CBR-3

Background

Case Presentations B and C

Case Presentation D

• The SARS-CoV-2 virus (Covid-19) became a global pandemic in March 2020 • Currently, there is only two medications that are FDA-approved for the treatment of Covid-19. • Those affected are mostly given supportive care, with some experiencing symptoms for months. • The use of the antiviral medication acyclovir has been suggested as a treatment for patients with long-term symptoms lasting more than a month and unusual presentations of the virus, such as encephalopathy or coagulopathy. • Acyclovir is a safe and efficacious drug acting as a competitive inhibitor of DNA polymerase through phosphorylation (antiviral medication) • Acyclovir is well tolerated with the most common adverse effect being fatigue. • Patient A : 77-year-old male • Presenting Symptoms: Memory loss, agitation diagnosed with COVID-19 • Other symptoms: Hyperverbia, flight of ideas • Dose of medication: Acyclovir 400 mg four times per day (QID) ‡…‡„‡” ʹͲʹͲǣ ƒ–‹‡– ”‡’‘”–‡†Ž› –‡•–‡† ’‘•‹–‹˜‡ ˆ‘” ƒ”…Š ʹͲʹͳǣ ƒ–‹‡– ‹‹–‹ƒŽ ’”‡•‡–ƒ–‹‘ ƒ– ’•›…Š‹ƒ–”‹… ‘ˆˆ‹…‡ ‡’–‡„‡” ʹͲʹͳǣ ƒ–‹‡– ”‡’‘”–‡† ”‡•‘Ž—–‹‘ ‘ˆ •›’–‘• Case Presentation A

• Patient B : 66-year-old male • Presenting Symptoms: Memory loss affecting work diagnosed with COVID-19 • Other symptoms: Brain fog, confusion • Dose of medication: Acyclovir 400 mg three times per day (TID)

• Patient D : 38-year-old female • Presenting Symptoms: intense body heat diagnosed with COVID-19 • Other symptoms: Lack of sweating • Dose of medication: Acyclovir 400 mg twice per day (BID)

‡„”—ƒ”› ʹͲʹͳǣ ƒ–‹‡– ”‡’‘”–‡†Ž› ƒ…“—‹”‡† ‡„”—ƒ”› ʹͲʹͳǣ ƒ–‹‡– ‹‹–‹ƒŽ ’”‡•‡–ƒ–‹‘ ƒ– ’•›…Š‹ƒ–”‹… ‘ˆˆ‹…‡

‡…‡„‡” ʹͲʹͳǣ ƒ–‹‡– ”‡’‘”–‡† ”‡•‘Ž—–‹‘ ‘ˆ •›’–‘•

‡„”—ƒ”› ʹͲʹͳǣ ‹–‹ƒŽ ’”‡•‡–ƒ–‹‘ ™‹–Š ’•›…Š‹ƒ–”›ǡ •Š‘™‡† ‘…Ž—•‹‘ ƒ† —Ž–‹ˆ‘…ƒŽ ’‡—‘‹ƒ

‡’–‡„‡” ʹͲʹͳǣ ƒ–‹‡– ”‡’‘”–‡† ”‡•‘Ž—–‹‘ ‘ˆ •›’–‘•

ƒ—ƒ”› ʹͲʹͳǣ ƒ–‹‡– ”‡’‘”–‡†Ž› –‡•–‡† ’‘•‹–‹˜‡ ˆ‘”

Figure 4 . Figure 4 demonstrates the trends in the titers for Patient D. A decreasing trend in both IgG and IgM shows a decreasing immune response from the body as the patient recovers from the disease.

Figure 2. Figure 2 demonstrates the trends in the titers for Patient B. A decreasing trend in both IgG and IgM shows a decreasing immune response from the body as the patient recovers from the disease. • Patient C : 66-year-old female • Presenting Symptoms: Insomnia, short term memory loss diagnosed with COVID-19 • Other symptoms: cough, hypertension, chest pain • Dose of medication: Acyclovir 400 mg TID

Discussion and Conclusions

• Treatment for Covid-19 encephalopathy is limited, and no drug has been FDA-approved for this use specifically • The patients described in this case series depict uncommon symptoms of encephalopathy after contracting the Covid-19 virus. • Treatment with acyclovir in these patients resolved their symptoms and lowered their IgG and IgM titers. • The patients in this series did not complain of medication side effects and have not reported a return of their symptoms since completing their treatment. • This case series supports the use of acyclovir as a safe and effective treatment for Covid-19 neurologic symptoms.

’”‹Ž – —Ž› ʹͲʹͳǣ ‡‹ˆ‡…–‹‘ǡ ‡™ •›’–‘• ‘ˆ Š›’‡”–‡•‹‘ ƒ† Š‡•– ’ƒ‹

‘˜‡„‡” ʹͲʹͲǣ ƒ–‹‡– ”‡’‘”–‡†Ž› ‹ˆ‡…–‡† ™‹–Š ǡ ”‡…‘˜‡”‡†

‡…‡„‡” ʹͲʹͳǣ ƒ–‹‡– ”‡’‘”–‡† ”‡•‘Ž—–‹‘ ‘ˆ ƒŽŽ •›’–‘•

References

Please scan for references list, or use the link: https://docs.google.com/document/d/e/2PACX 1vSuio_JvQ8uOywbE54UnAVKnJL9QYYj8v2PcZXmDy_kNv SG5lBmKanBRyPi4oW0MN-po23s6XxQiBMW/pub

Figure 1. Figure 1 demonstrates the trends in the titers for Patient A. A decreasing trend in both IgG and IgM indicates a decreasing immune response from the body as the patient recovers from the disease.

Figure 3 . Figure 3 demonstrates the trends in the titers for Patient C. A decreasing trend in both IgG and IgM shows a decreasing immune response from the body as the patient recovers from the disease.

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