Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jun 16, 2021; 9(17): 4310-4317
Published online Jun 16, 2021. doi: 10.12998/wjcc.v9.i17.4310
Acute liver failure with thrombotic microangiopathy due to sodium valproate toxicity: A case report
Xuan Mei, Hai-Cong Wu, Mei Ruan, Li-Rong Cai
Xuan Mei, Hai-Cong Wu, Li-Rong Cai, Department of Hepatobiliary Internal Medicine, The 900th Hospital of PLA Joint Logistics Support Force, Fuzhou 350025, Fujian Province, China
Mei Ruan, Department of Hepatobiliary Internal Medicine, The third affiliated people's hospital of FuJian University of traditional Chinese medicine, Fuzhou 350100, Fujian Province, China
Author contributions: Mei X analyzed the data, reviewed the literature, and wrote the manuscript; Ruan M and Cai LR performed the diagnostic investigations and treatments, and collected the data; Wu HC followed the patient and reviewed and revised the manuscript; all authors have read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient’s family for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest to report.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hai-Cong Wu, MS, Attending Doctor, Department of Hepatobiliary Internal Medicine, The 900th Hospital of PLA Joint Logistics Support Force, No. 156 North of West Second Ring Road, Gulou District, Fuzhou 350025, Fujian Province, China. 847614051@qq.com
Received: January 10, 2021
Peer-review started: January 10, 2021
First decision: February 11, 2021
Revised: February 21, 2021
Accepted: April 2, 2021
Article in press: April 2, 2021
Published online: June 16, 2021
Processing time: 135 Days and 19.8 Hours
Abstract
BACKGROUND

Sodium valproate is widely used in the treatment of epilepsy in clinical practice. Most adverse reactions to sodium valproate are mild and reversible, while serious idiosyncratic side effects are becoming apparent, particularly hepatotoxicity. Herein, we report a case of fatal acute liver failure (ALF) with thrombotic microangiopathy (TMA) caused by treatment with sodium valproate in a patient following surgery for meningioma.

CASE SUMMARY

A 42-year-old man who received antiepileptic treatment with sodium valproate after surgery for meningioma exhibited extreme fatigue, severe jaundice accompanied by oliguria, soy sauce-colored urine, and ecchymosis. His postoperative laboratory values indicated a rapid decreased platelet count and hemoglobin level, severe liver and kidney dysfunction, and disturbance of the coagulation system. He was diagnosed with drug-induced liver failure combined with TMA. After plasma exchange combined with hemoperfusion, pulse therapy with high-dose methylprednisolone, and blood transfusion, his liver function deteriorated, and finally, he died.

CONCLUSION

ALF with TMA is a rare and fatal adverse reaction of sodium valproate which needs to be highly valued.

Keywords: Sodium valproate; Drug-induced liver injury; Thrombotic microangiopathy; Plasma exchange; Organ transplantation; Case report

Core Tip: Sodium valproate is widely used in the treatment of epilepsy in clinical practice although it has potential hepatotoxicity. Herein, we report a case of fatal acute liver failure (ALF) with thrombotic microangiopathy (TMA) caused by sodium valproate treatment. A history of chronic hepatitis B virus infection or combination therapy with sodium valproate and carbapenem may increase the risk of ALF. The combination therapy of plasma exchange, glucocorticoid, and supportive therapy is essential for TMA. Organ transplantation at the early stage of the disease may be the first choice for critically ill patients. Our case report can facilitate further studies on the diagnosis and therapy of ALF with TMA.