Valproic acid triggers acute rhabdomyolysis in a patient with carnitine palmitoyltransferase type II deficiency.
A 47-year-old man suffering from a bipolar disorder and intermittent myoglobinuria presented with acute rhabdomyolysis with renal failure after starting therapy with valproic acid. On morphological examination, skeletal muscle revealed increased lipid storage. Biochemically, decreased enzyme activity of carnitine palmitoyltransferase (CPT) type II with carnitine levels in the lower limit was found. Genetic analysis detected the common Ser113Leu substitution on one allele of the CPT2 gene. We conclude that valproic acid should be avoided in patients with CPT type II deficiency.
Kottlors
M
M
Department of Neurology, University of Freiburg, 79106 Freiburg, Germany. kottlors@nz11.ukl.uni-freiburg.de
Jaksch
M
M
Ketelsen
U P
UP
Weiner
S
S
Glocker
F X
FX
Lücking
C H
CH
D000108:Acetylcarnitine / Q000032:analysis / Q000378:metabolism; D000208:Acute Disease; D018692:Antimanic Agents / Q000009:adverse effects*; D001714:Bipolar Disorder / Q000150:complications / Q000188:drug therapy*; D002334:Carnitine O-Palmitoyltransferase / Q000172:deficiency* / Q000235:genetics / Q000378:metabolism; D006801:Humans; D008052:Lipid Metabolism, Inborn Errors / Q000150:complications / Q000175:diagnosis / Q000201:enzymology; D008297:Male; D008875:Middle Aged; D028361:Mitochondrial Diseases / Q000150:complications / Q000175:diagnosis / Q000201:enzymology; D018482:Muscle, Skeletal / Q000378:metabolism / Q000473:pathology; D009154:Mutation; D009212:Myoglobinuria / Q000209:etiology; D012206:Rhabdomyolysis / Q000139:chemically induced* / Q000175:diagnosis* / Q000201:enzymology; D014635:Valproic Acid / Q000009:adverse effects*
D018692:Antimanic Agents; D014635:Valproic Acid; D000108:Acetylcarnitine; D002334:Carnitine O-Palmitoyltransferase