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Abstract

Introduction: Fulminant hepatitis induced by Valproic Acid (VPA) occurs especially in children under two years of age, polypathological, polymedicated, and often with inborn errors of metabolism and mental retardation. It remains an exceptional iatrogenic accident in healthy adults with a prevalence not exceeding 0.01 to 0.02%, and usually fatal.

We are reporting an original observation of spontaneously resolved VPA-induced fulminant hepatitis in competent healthy adult.

Case report: A 24-year-old woman treated with VPA (Depakine chrono®500 mg, 1200 mg/day) for three weeks because of epilepsy was hospitalized for jaundice, vomiting, and alteration of her general condition that had been evolving for two days. Clinical examination noted a patient with fever at 38°C, cutaneous and mucous jaundice, tremor flapping, temporospatial disorientation, and Glascow Coma Score at 14/15. The biology showed: ASAT at 1865 IU/l, ALAT at 1986 IU/l, TB at 253 μmol/l, DB at 152 μmol/l, and PT at 45%. Factor V was at 38% and the rest of the basic bioassays were within normal limits.

Further investigations were negative. The diagnosis of VPA-induced fulminant hepatitis with acute hepatic failure and hepatic encephalopathy was retained. After discontinuation of the culprit drug and intensive resuscitation the evolution was favorable. All liver tests were strictly normal after one month.

Conclusion: VPA-induced fulminant hepatitis should be known and systematically evoked in front of any unexplained symptom in patient treated with this anticonvulsant drug. Only early diagnosis makes it possible to envisage rapid and adapted management, and thus improve the spontaneously fatal prognosis of these iatrogenic accidents.

Keywords: Fulminant hepatitis; Valproic acid; Drug toxicity; Iatrogenesis