AI Article Synopsis
- Valproic acid (VPA) is a common anticonvulsant that can cause side effects like bone marrow suppression and cytopenia, but myelodysplasia linked to VPA is less understood.
- A case involving a 9-year-old girl with seizures showed symptoms including fevers, fatigue, weakness, and bruising, with blood tests revealing low platelet counts and atypical cells in her bone marrow.
- After discontinuing VPA, her blood counts returned to normal within 7 months, highlighting the importance of considering VPA's effects on bone marrow when diagnosing similar conditions in children and the elderly.
Article Abstract
Objective: Valproic acid (VPA) is an effective first-line anticonvulsant that is associated with several side effects including bone marrow suppression and subsequent cytopenia. However, VPA associated myelodysplasia is not a well described entity that can be seen in patients on VPA treatment.
Case Report: Herein, we describe a 9-year-old female patient with a past medical history of seizure disorder who presented with 3-week history of intermittent fevers, fatigue, weakness, and multiple unexplained bruises. Complete blood count (CBC) was remarkable for marked thrombocytopenia. Trephine biopsy showed a normocellular marrow with maturing trilineage hematopoiesis and scattered atypical megakaryocytes including numerous small hypolobated forms with frequent forms showing separated nuclei. Her CBC showed normalization 7 months after VPA was stopped.
Conclusions: The presence of bone marrow suppression and myelodysplasia in patients on VPA treatment should be taken into consideration as it can cause a diagnostic pitfall especially in pediatric and elderly populations. A careful review of past medical history and medications can help make the correct diagnosis.
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