Valproic Acid-Induced Eosinophilic Pleural Effusion

Abstract

We present a case of eosinophilic pleural effusion due to valproic acid (VPA), a rare adverse event that has been reported previously. A 30-year-old male patient presented with respiratory symptoms and right-sided pleuritic pain, within days of initiation of VPA treatment for a generalized seizure. Chest radiography revealed a moderate-sized right-sided pleural effusion, which was an exudate with a pH of 7.54 and 48% eosinophils. Symptoms resolved soon after discontinuation of the drug, as did the effusion in a repeat radiograph 3 weeks later. The likelihood that VPA was the cause of the effusion is examined.

Pericardial and Pleural Effusion with Valproic Acid use in a Patient with Bipolar Disorder

“…Although how drug-induced PE emerges still remains unknown, there are various assumptions suggesting some factors such as an acute hypersensitivity reaction, a direct dose-related toxic effect, drug-induced inflammation in the pleural space or mesothelial cell injury 1,3 . In cases where eosinophilia is present when there is eosinophilic effusion, the independence from the duration of drug use and an unclear association with the drug dose highly strengthen the possibility of a hypersensitivity reaction.…”

“…İki uçlu bozukluğu olan bir hastada valporik asit nedenli perikardiyal ve plevral efüzyon considered idiopathic were actually druginduced 1,13 . We report a case of PE in a patient treated with VPA and examine the likelihood that this drug was the cause of the effusion.…”

“…Valproic acid (VPA) is a commonly used drug in the treatment of diseases such as mood disorders, impulse control disorders, epilepsy and migraines 1 . This medication functions by increasing the efficacy of gamma-amino butyric acid over voltage-gated sodium channels and has different action mechanisms such as effect on the lower units of neural signal transduction.…”

“…Possible side effects include gastrointestinal symptoms, sedation, hair loss, weight gain, or tremors, and it is known to elevate transaminases in 5-40% of patients. Adverse effects like fetal hepatotoxicity, agranulocytosis and encephalopathy are rarely reported in the literature 1,2 . It is also reported that pleural effusion (PE) may rarely occur due to the use of VPA 3 .…”

“…It is also reported that pleural effusion (PE) may rarely occur due to the use of VPA 3 . In the literature, 13 cases of PE developing due to the use of VPA have been reported so far [1][2][3][4][5][6][7][8][9][10][11] . In an animal study investigating teratogenic effect of VPA, the development of drug-induced PE has also been reported 12 .…”