Munhoz R P, dos Santos M L, Hernández-Fustes O J
Serviço de Neuropediatria, Hospital Infantil Pequeno Príncipe, Curitiba, PR, Brasil.
Arq Neuropsiquiatr. 2001 Sep;59(3-B):821-3.
Among the idiosyncratic reactions related to VPA, pancreatitis is the most rare and less remembered even though its potentially fatal course. We report the case of a 5 year-old boy with epilepsy treated with VPA 40 mg/kg/day associated with CBZ 20 mg/kg/day and PB 3 mg/kg/day, admitted for vomiting, abdominal pain, low grade fever, abdominal tension and amylasis of 288 UI. On evolution presented upper digestive hemorrhage, shock and amylasis of 564 UI. The patient was submitted to exploratory laparotomy with findings of hemorrhagic ascitis, retroperitoneal hematoma, increased volume of pancreas with edema and hemorrhage leading to diagnosis of necro-hemorrhagic pancreatitis and a fatal course. Pancreatic complications are well known complications related to VPA treatment and may vary between asymptomatic hyperamilasemy to fatal acute pancreatitis. The characteristics of our patient correlates with the data on literature: we found 7 similar cases reported, 4 of which died.
在与丙戊酸（VPA）相关的特异反应中，胰腺炎最为罕见，即便其病程可能致命，却也较少被人记住。我们报告了一例5岁癫痫男孩的病例，该男孩接受每日40mg/kg的VPA治疗，同时联用每日20mg/kg的卡马西平（CBZ）和每日3mg/kg的苯巴比妥（PB），因呕吐、腹痛、低热、腹部紧张及淀粉酶水平为288国际单位（UI）而入院。病情进展过程中出现上消化道出血、休克，淀粉酶水平升至564 UI。患者接受了剖腹探查术，结果发现出血性腹水、腹膜后血肿、胰腺体积增大伴水肿和出血，最终诊断为坏死性出血性胰腺炎，并导致死亡。胰腺并发症是与VPA治疗相关的已知并发症，其表现可能从无症状高淀粉酶血症到致命性急性胰腺炎不等。我们患者的特征与文献数据相符：我们发现有7例类似病例报告，其中4例死亡。
