Pancreatitis, complicated by a pancreatic pseudocyst associated with the use of valproic acid

Abstract

SummaryA 12-year-old boy developed pancreatitis, complicated by a pancreatic pseudocyst, as an adverse reaction to valproic acid (VPA) treatment for epilepsy. Pancreatitis subsided within three weeks after discontinuation of VPA. The pancreatic pseudocyst was managed without surgery and resolved spontaneously in four weeks. Valproic acid was concluded to be the most probable cause, since no other explanation was found. According to the literature VPA is a rare but known cause of pancreatitis.A computer-assisted literature search revealed seven previously reported cases of VPA-induced pancreatitis complicated by a pancreatic pseudocyst. Six of these patients were under 20 years of age. Four patients were treated conservatively; three needed cystostomy or external drainage. All patients recovered.Patients using VPA, especially children, presenting with acute abdominal pain should be suspected of valproic acid-induced pancreatitis. If VPA induced pancreatitis is complicated by a pseudocyst, conservative treatment should be the first line of treatment. Q 2005 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved. CaseA 12-year-old boy presented at the pediatric ward of our hospital with intermittent upper abdominal pain that started two weeks before. The pain attacks lasted for several minutes, and were less painful when the boy was lying still with his legs flexed. The attacks occurred 4-8 times a day. On examination the boy appeared moderately ill. His body weight was 45 kg and his temperature was 38 8C. He had no signs of jaundice nor did the skin reveal any haematomas. The bowel sounds were normal but there was some left upper abdominal tenderness. The liver and spleen were not enlarged, nor were any abnormal masses felt.

Valproic acid-induced pancreatitis: 16 new cases and a review of the literature

“…[7][8][9][10][12][13][14][15][16] Details for children and adults are summarized in Tables 2 and 3, respectively.…”

“…11 The incidence of acute pancreatitis in children in general is estimated as 2-2.7 : 100 000. 12 The etiologies of pancreatitis in childhood are mostly trauma, biliary disease, infections, and side effects of drugs. 13 Drug-induced pancreatitis has been postulated in approximately 13% of all children with acute pancreatitis.…”

“…13 Drug-induced pancreatitis has been postulated in approximately 13% of all children with acute pancreatitis. 12 The mechanism of VPA-coincident acute pancreatitis is "idiosyncratic," 14 a direct toxic effect of free radicals on the pancreatic cell membrane by depletion of superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase has been assumed. 15,16 Background.…”

Alta frecuencia de pancreatitis aguda asociada a patología biliar en niños chilenos

“…La incidencia encontrada para PA idiopática es semejante a la reportada en la literatura, alrededor de un 20%, sin embargo, la incidencia de PA secundaria a drogas (22,2%) es muy superior a los datos disponibles en la literatura, que reportan valores entre 3,2% y 13% 2,14 del total de pacientes. Algunos autores postulan que el ácido valproíco es la droga que más frecuentemente se asocia a PA en niños 14,15 , lo cual está en concordancia con los hallazgos de nuestro estudio.…”

Syndrome démentiel et extrapyramidal iatrogène : effet secondaire rare de l’association acide valproïque-aspirine

“…Sa tolérance est bonne et sa surveillance biologique facile. Les effets secondaires les plus sévères mais exceptionnels sont digestifs (hépatites, pancréatites [1]) et leur risque de survenue est majoré par la coprescription d'autres anti-épileptiques. Des syndromes parkinsoniens transitoires ont été rapportés chez des enfants et des adultes jeunes [2,3], de même qu'un cas de démence réversible [4].…”