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Fatality from hepatitis A in a child taking valproate.

M Fayad1, R Choueiri, M Mikati

  • 1Department of Pediatrics and Epilepsy Program, American University of Beirut Medical Center, Lebanon. mrfayad@dm.net.lb

Journal of Child Neurology
|March 1, 2000
PubMed
Summary
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Valproate medication may increase the risk of severe liver injury in children with hepatitis A. Hepatitis A vaccination is recommended for children on valproate in endemic areas.

Area of Science:

  • Pediatric Neurology
  • Hepatology
  • Pharmacology

Background:

  • Valproate is a widely used antiepileptic drug.
  • Congenital stroke can cause complex partial seizures in children.
  • Hepatitis A is typically a self-limiting liver infection in children.

Observation:

  • An 8-year-old boy on long-term valproate therapy developed fulminant hepatic failure and encephalopathy following hepatitis A infection.
  • Despite prompt medical intervention and discontinuation of valproate, the patient's condition rapidly deteriorated.
  • Liver pathology showed characteristic changes of severe hepatotoxicity.

Findings:

  • This case represents a rare instance where a typically benign hepatitis A infection became fatal in a child treated with valproate.

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  • Literature review identified four previous cases of valproate-associated hepatitis A-induced liver failure, though all recovered.
  • The patient's fatal outcome suggests a potential synergistic hepatotoxic effect between valproate and hepatitis A.

    • Implications:

    • Hepatitis A vaccination should be strongly considered for children on valproate therapy, especially those residing in or traveling to endemic regions.
    • This case highlights the importance of considering potential drug-induced exacerbation of infections.
    • Further research into the interaction between valproate and viral hepatitis is warranted to elucidate the underlying mechanisms of severe hepatotoxicity.