PDF(Pubmed)
Abstract：
Valproic acid (VPA) is a commonly used antiepileptic drug (AED). Aplastic crisis is defined as acute arrest of hematopoiesis. Stevens-Johnson syndrome (SJS) is a fatal cutaneous adverse drug reaction. We herein report a rare case of aplastic crisis and SJS in a single pediatric patient that were probably caused by VPA. A 2-year-old girl was involved in a car accident. She was diagnosed with skull fractures, cerebral contusions, pulmonary contusions, and fractures of the left iliac bone by computed tomography. VPA was administered as prophylaxis for post-traumatic epilepsy. From day 13, she developed repeated high fevers, and multiple antibiotics were ineffective; she was then transferred to our pediatric intensive care unit. After transfer, she developed liver function impairment, decreased peripheral blood cell counts, and skin damage. After withdrawal of the VPA and administration of prednisone, intravenous immunoglobulin, local skin care, and nutritional support, her body temperature normalized and her hematopoietic function and skin lesions successively resolved. She was transferred out of the pediatric intensive care unit on day 56 and discharged on day 70. At the 6-month follow-up, a blood examination was normal, and repeat computed tomography revealed multiple softening foci of the bilateral brain and less subdural effusion than before. To our knowledge, no report to date has described aplastic crisis and SJS in a single patient. The purpose of this paper is to increase clinicians\' knowledge in the treatment of adverse drug reactions (ADRs) and emphasize the importance of standardized application and strict monitoring of VPA in patients with post-traumatic brain trauma.
摘要：
丙戊酸(VPA)是一种常用的抗癫痫药物(AED)。再生障碍性危机被定义为造血功能的急性停止。Stevens-Johnson综合征(SJS)是一种致命的皮肤药物不良反应。我们在此报告了一例可能由VPA引起的儿童再生障碍性疾病和SJS的罕见病例。一名2岁女孩遭遇车祸。她被诊断出颅骨骨折,大脑挫伤,肺挫伤,计算机断层扫描显示左髂骨骨折。VPA用于预防创伤后癫痫。从第13天开始，她反复发烧，多种抗生素无效;然后她被转移到我们的儿科重症监护室。转移后,她出现了肝功能损害,外周血细胞计数减少，和皮肤损伤。VPA停药和泼尼松后，静脉注射免疫球蛋白，局部皮肤护理,和营养支持，她的体温恢复正常，造血功能和皮肤损伤相继解决。她在第56天被转移出儿科重症监护病房，并在第70天出院。在6个月的随访中，血液检查正常,重复计算机断层扫描显示双侧大脑有多个软化灶，硬膜下积液比以前少。据我们所知,迄今为止,尚无任何报告描述1例患者的再生障碍性疾病和SJS.本文的目的是提高临床医生对药物不良反应（ADR）治疗的认识，并强调规范应用和严格监测VPA在脑外伤后患者中的重要性。
