Fayad M, Choueiri R, Mikati M
Department of Pediatrics and Epilepsy Program, American University of Beirut Medical Center, Lebanon.
J Child Neurol. 2000 Feb;15(2):135-6. doi: 10.1177/088307380001500215.
We report an 8-year-old boy with complex partial seizures due to congenital stroke, treated with valproate for more than 3 years (the last 2 years were on monotherapy) with no complications during that period except for transient thrombocytopenia. His sister had uncomplicated hepatitis A. One month later, the patient became jaundiced, went into fulminant hepatic failure, and quickly became encephalopathic despite discontinuation of valproate, aggressive supportive therapy, and treatment with carmitine. He then died. He had positive hepatitis A IgM; other causes for acute hepatitis were ruled out. Liver pathology revealed distended hepatocytes with cholestasis and microvesicular changes. We could find in the literature two other articles on four cases who developed liver failure with hepatitis A while on valproate. All those cases, however, recovered. In our patient a usually benign disease became deadly, probably because of the concomitant use of a hepatotoxic medication. Immunizing, with hepatitis A vaccine, all children on valproate therapy who are living in, or traveling to, endemic areas should be considered and is probably advisable.
我们报告了一名8岁男孩，因先天性中风患有复杂部分性癫痫，使用丙戊酸盐治疗超过3年（最近2年为单药治疗），在此期间除短暂性血小板减少外无其他并发症。他的姐姐患有无并发症的甲型肝炎。一个月后，该患者出现黄疸，进展为暴发性肝衰竭，尽管停用了丙戊酸盐、采取了积极的支持治疗并使用了肉碱治疗，但仍迅速出现肝性脑病。随后他死亡。他的甲型肝炎IgM呈阳性；排除了急性肝炎的其他病因。肝脏病理显示肝细胞肿胀，伴有胆汁淤积和微泡样改变。我们在文献中还发现另外两篇关于4例在使用丙戊酸盐期间因甲型肝炎而发生肝衰竭的病例报道。然而，所有这些病例均康复。在我们的患者中，一种通常为良性的疾病变得致命，可能是因为同时使用了肝毒性药物。对于所有正在接受丙戊酸盐治疗、生活在甲型肝炎流行地区或前往该地区旅行的儿童，应考虑并可能建议接种甲型肝炎疫苗。
