Stevens-Johnson syndrome induced by sodium valproate: a case report and literatures review

Abstract

Objective To explore the clinical diagnosis and treatment of Stevens-Johnson syndrome induced by sodium valproate. Methods The clinical manifestations, investigation findings and treatment of 1 patient with Stevens-Johnson syndrome induced by sodium valproate, and the related literatures were reviewed. Results The patient was a 3.5-year-old girl who was initially diagnosed with epilepsy.After 14 days of monotherapy with oral sodium valproate, an erythematous rash appeared on the face, and gradually spread to her trunk and limbs with severe itching.The rash rapidly got worsened, and developed flakiness and herpetic lesions that involved swelling and ulceration of the lip mucosa.Two days after the rash appeared, she became febrile with body temperature up to 39.5 ℃.Lymphadenectasis and a palpable 2 cm liver edge were found on examination.Her glutamate pyruvate transaminase was 139 IU/L and the concentration of blood ammonia was 108 μmol/L.The administration of sodium valproate was discontinued imme-diately and methylprednisolone intravenous pulse therapy [15 mg/(kg·d)] was administered.Two days later, she was afebrile and the rash gradually resolved within 7 days of treatment.Her liver function also returned to normal. Conclusions A high degree of vigilance against sodium valproate-induced Stevens-Johnson syndrome was crucial to the early clinical diagnosis and successful treatment of this patient.The prompt discontinuation of the causative medication and sufficient corticosteroid hormone therapy can achieve a good outcome. Key words: Sodium valproate; Monotherapy; Stevens-Johnson syndrome