[Fatal pancreatitis associated with valproate therapy]

Area of Science:

• Neurology
• Gastroenterology
• Pathology

Background:

• Sodium valproate (VPA) is a widely used antiepileptic drug.
• Pancreatitis is a known, though rare, adverse effect of VPA therapy.
• The clinical presentation of VPA-induced pancreatitis can mimic other gastrointestinal issues.

Observation:

• A 15-year-old male with epilepsy on long-term VPA treatment presented with acute abdominal pain, nausea, and vomiting.
• Elevated serum amylase levels and findings from two exploratory laparotomies confirmed severe haemorrhagic pancreatitis with necrosis.
• Despite VPA discontinuation, the patient's condition deteriorated, leading to a fatal outcome.

Findings:

• The autopsy revealed extensive haemorrhagic pancreatic necrosis, consistent with VPA-induced pancreatitis.
• The case highlights a fatal outcome despite discontinuation of the suspected causative agent.
• Vomiting and abdominal pain are common VPA side effects, but severe presentations warrant consideration of pancreatitis.

Implications:

• Clinicians should maintain a high index of suspicion for VPA-related pancreatitis in patients presenting with severe abdominal symptoms.
• Early recognition and immediate cessation of VPA therapy are crucial for potentially preventing severe or fatal outcomes.
• This case underscores the importance of monitoring for rare but life-threatening adverse drug reactions.