Drug hypersensitivity syndrome induced by sodium valproate

Abstract

A 20-year-old male with athetosis received sodium valproate 500 mg twice daily. Twenty days after treatment, the patient developed general erythematous which faded after pressing, increased skin temperature, facial swelling, and enlargement of superficial lymph node in his head and neck. Laboratory tests showed the following values: white blood cell (WBC) 18.3×109/L, neutrophils 0.392, lymphocytes 0.364, monocytes 0.137, eosinophils 0.097, procalcitonin (PCT) 0.3 μg/L, alanine aminotransferase (ALT) 311 U/L, aspartate aminotransferase (AST) 148 U/L, alkaline phosphatase (ALP) 295 U/L, gamma-glutamyl transferase (γ-GT) 169 U/L. The patient was diagnosed as drug induced hypersensitivity syndrome (DIHS). Valproate was withdrawn. He received the symptomatic treatments which included glucocorticoid, antihistamines, liver protection and topical medication. Twenty days later, his erythematous rash were disappeared mainly. Fifty-five days later, his erythematous rash disappeared completely. Laboratory tests showed the following values: WBC 8.6×109/L, eosinophils 0.005, ALT 32 U/L, AST 22 U/L, ALP 66 U/L, γ-GT 67 U/L. Key words: Valproic acid; Hypersensitivity