Reactions 1215 - 16 Aug 2008

SOxcarbazepine/valproic acid

Systemic lupus erythematosus in a child: casereport

A 7-year-old boy developed systemic lupus erythematosuswhilst receiving oxcarbazepine and valproic acid for recurrentseizures.

Six months previously, during treatment with oxcarbazepinemonotherapy [dosage and duration of therapy not stated], theboy complained of arthralgia and stiffness. Laboratoryexaminations revealed elevated ESR and CRP levels andpositivity for antinuclear antibody (ANA). He receivednaproxen, although intermittent arthralgia and arthritispersisted. Three months later, valproic acid [dosage not stated]was initiated, then after another month levetiracetam wasadded and oxcarbazepine was reduced. One week later,45 days after commencing valproic acid, he developed fever,loss of appetite and weight loss, finger and toe joint swelling,arthralgia and myalgia. He was admitted to hospital about1 month later, where examination revealed lymphadenopathy,hepatosplenomegaly, and arthritis in his hands, wrists andankles. Laboratory tests showed the following levels: ESR87 mm/hr, CRP 7.6 mg/dL, C3 92.6 mg/dL, C4 15 mg/dL, WBC2800/mm3, haemoglobin 10.7 g/dL and creatinine 0.4 mg/dL.He tested positive for D. Coombs (+++), ANA (++++;1/1000), anti-histone antibodies (+) and anti-nucleosomeantibodies (+). He was diagnosed with drug-induced lupus.

Oxcarbazepine was discontinued and valproic acid wasgradually withdrawn. The boy started receiving steroids andhis symptoms disappeared within 2 days. His laboratory levelshad improved 2 weeks later, and his ANA had decreased to1/80 after 7 months.

Author comment: "Our patient’s initial complaints. . .began while he was on single oxcarbazepine therapy.Therefore metabolites of oxcarbazepine might have probablycaused the scenario in our patient. . . Valproic acid mighthave also made the second hit in our patient".Ozcakar ZB, et al. Oxcarbazepine and valproic acid-induced lupus in a 7-year-oldboy. Acta Paediatrica 97: 1000-1001, No. 8, Aug 2008 - Turkey 801117440

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Reactions 16 Aug 2008 No. 12150114-9954/10/1215-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved