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Idiosyncratic Valproic Acid-Induced Hepatotoxicity in a Sickle Cell Patient
Christo Cimino1, Lisa Charneski2, Lisa Kumar3
1Penn Presbyterian Medical Center, Philadelphia, PA, USA.
Valproic acid may cause liver damage (hepatotoxicity) in patients with sickle cell disease. Discontinuing the drug led to rapid symptom improvement, highlighting the need for pharmacist vigilance in managing adverse drug events.
Area of Science:
- Hepatology
- Pharmacology
- Clinical Toxicology
Background:
- Valproic acid is a widely used antiepileptic and migraine-preventive medication.
- Idiosyncratic drug-induced liver injury (DILI) is a significant concern with valproic acid.
- Sickle cell disease patients may have unique susceptibilities to drug toxicity.
Observation:
- A 32-year-old female with sickle cell anemia and cerebral palsy presented with worsening transaminitis and hyperbilirubinemia.
- The patient had been taking valproic acid for chronic migraine prevention for six years.
- Extensive workup for underlying liver disease was inconclusive.
Findings:
- Discontinuation of valproic acid on hospitalization day 3 resulted in rapid improvement of hepatotoxicity signs and symptoms.
- The Council for International Organizations of Medical Sciences scale indicated a probable drug-related adverse event.
- This case supports valproic acid-induced hepatotoxicity as a potential diagnosis in susceptible patients.
Implications:
- Prompt identification and management of valproic acid-induced hepatotoxicity by pharmacists are crucial.
- Clinicians should consider valproic acid as a potential cause of liver injury in patients with sickle cell disease.
- This case underscores the importance of considering drug-induced liver injury even in patients with complex medical histories.
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