Case Report: Reversible myelodysplastic syndrome secondary to sodium valproate in an epileptic child

We report a rare case of sodium valproate (VPA)-induced reversible myelodysplastic syndrome (MDS) in an Asian child with epilepsy, thus expanding the recognition of VPA-associated hematological toxicity. Although VPA has been widely used, the reversibility of MDS as a complication remains underreported, particularly in pediatric populations.

A 9-year-old boy with epilepsy developed pancytopenia (hemoglobin level: 77 g/L, platelet count: 83 × 10⁹/L) and bone marrow-confirmed MDS after 6 months of VPA therapy. Following a reduction in VPA dose to 250 mg/day with adjunctive lacosamide, hematological parameters normalized within 3 months, and a repeat bone marrow examination revealed resolution of dysplastic features. Seizure control was maintained without relapse. This case highlights the dose-dependent nature of VPA-induced MDS and demonstrates its reversibility upon therapeutic intervention.

The reversibility of VPA-induced MDS following dose adjustment underscores the importance of vigilant hematological monitoring in children.