Possible induction of systemic lupus erythematosus by valproate.
Two patients developed clinical and laboratory evidence of systemic lupus erythematosus (SLE) during treatment with valproate (VPA) preparations. The first patient, a 47-year-old man, had fever, malaise, and thrombocytopenia 1 month after VPA was added to phenytoin (PHT) and primidone (PRM). He developed high titers of antinuclear antibodies (ANA) and anti-DNA antibodies, and hypocomplementemia. After discontinuation of PHT and VPA, steroid and immunoglobulin treatment was required for 4 weeks before his condition improved. The second patient, a 28-year-old woman, had been followed for idiopathic leukopenia for 3 years and had previously experienced fever and lymphadenopathy from PHT. After 4 months of divalproex therapy, she developed confusion, joint pain, and a dramatic increase in seizure frequency. She also developed high titers of ANA and anti-DNA antibodies and hypocomplementemia, along with a further decrease in white blood cell (WBC) count. These responded to steroid therapy and withdrawal of divalproex. Three months later, reintroduction of divalproex was followed by a return of ANA in low titer, which resolved after discontinuation. We believe that VPA may have caused true SLE in these patients, one of whom was probably predisposed.
Bleck
T P
TP
Department of Neurological Sciences, Rush Medical College, Chicago, IL 60612.
Smith
M C
MC
D000328:Adult; D000974:Antibodies, Antinuclear / Q000032:analysis; D004833:Epilepsy, Temporal Lobe / Q000188:drug therapy; D005260:Female; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000139:chemically induced* / Q000276:immunology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D012640:Seizures / Q000188:drug therapy; D014635:Valproic Acid / Q000009:adverse effects* / Q000097:blood
D000974:Antibodies, Antinuclear; D014635:Valproic Acid