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[Valproate sodium and zonisamide associated interstitial pneumonitis in an infant]

Koki Nikaido1, Takahiro Kato, Rumiko Takayama

  • 1Department of Pediatrics, Sapporo Medical University School of Medicine, Sapporo, Hokkaido. knikaido@szec.hosp.go.jp

No to Hattatsu = Brain and Development
|January 19, 2007
PubMed

Insights

Valproate sodium and zonisamide treatment in an infant with epileptic spasms led to interstitial pneumonitis. Prompt treatment, including medication withdrawal, resolved the condition, suggesting an allergic drug reaction.

Area of Science:

  • Pediatric Pulmonology
  • Clinical Pharmacology
  • Toxicology

Background:

  • Infantile epileptic spasms require effective treatment.
  • Anticonvulsant medications like valproate sodium (VPA) and zonisamide (ZNS) are commonly used.
  • Drug-induced lung injury is a potential, though rare, complication.

Observation:

  • A six-month-old infant on VPA and ZNS developed dyspnea.
  • Dyspnea worsened with respiratory syncytial virus (RSV) infection.
  • Interstitial pneumonitis (IP) was diagnosed via chest CT and elevated KL-6/surfactant protein D levels.

Findings:

  • The infant's IP was likely an allergic reaction, evidenced by steroid responsiveness.
  • Exacerbating factors included dual anticonvulsant use, RSV infection, and infant physiology (low IgA).
  • Discontinuation of VPA/ZNS and treatment with steroids and neutrophil elastase inhibitor led to improvement.

Implications:

  • Clinicians should consider drug-induced interstitial lung disease in infants presenting with respiratory distress during anticonvulsant therapy.
  • VPA and ZNS are potential triggers for interstitial pneumonitis.
  • Early recognition and management, including medication review, are crucial for favorable outcomes.

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