Valproic acid
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Eosinophilic lung disease: case report A 47-year-old man developed eosinophilic lung disease during treatment with valproic acid for generalised tonic-clonic seizure [route not stated]. The man presented with dyspnoea, fatigue and chills. He had a history of chronic pansinusitis, community-acquired pneumonia and epilepsy. An anamnesis showed that he had developed probably generalised tonic-clonic seizure approximately before 16 years, and therefore, he started receiving valproic acid [initial dosage not stated]. After 5 years of the therapy, valproic acid was tapered to 1000 mg/day. Two years later, he developed another generalised tonic-clonic seizure, requiring continuation of valproic acid. Concurrently, he had been receiving budesonide/formoterol for bronchial asthma. Thereafter, he remained seizure-free. He never smoked. At the current presentation, the pulmonary auscultation findings were normal. The chest X-ray revealed multiple bilateral nodules bilaterally with a C-reactive protein (CRP) level of 39 mg/L. The man was treated with amoxicillin/clavulanic acid. A chest CT scan demonstrated partly necrotising nodules in the both lungs. Laboratory findings showed leukocytes 7100 /uL, eosinophilic granulocytes 13.4%, CRP 5.5 mg/L and negative c-ANCA and pANCA. Further, a bronchoscopy was performed, which showed that the bronchoalveolar lavage was moderately high in cells with low-grade eosinophilia. Histology revealed normal bronchial epithelial cells with individual inflammatory cells and macrophages, moderate chronic and florid, partially eosinophilic bronchitis with minor, partly eosinophilic peribronchitis and alveolitis with macrophagocytic alveolitis. The microbiological testing of the bronchial secretions showed no microorganisms pathological to humans. He was treated with prednisolone. At 2 months follow-up, he reported a clinical improvement with still limited strain bearing capacity and persistent dyspnoea. The bilateral infiltrative changes in the chest X-ray and eosinophilia had completely resolved. Following literature search, eosinophilic pulmonary diseases due to valproic acid was suspected. Therefore, valproic acid was changed to levetiracetam. His prednisolone dose was tapered. After two months, he had no complaints. Radiographic followups described normal findings, but the body plethysmography only showed mild central obstruction. Stolpe C, et al. A Rare Cause of a Eosinophilic Lung Disease. Pneumologie : 14 Sep 2020. Available from: URL: http://doi.org/10.1055/a-1220-7149 [German; summarised 803507669 from a translation]
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Reactions 17 Oct 2020 No. 1826
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