Valproic acid
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Eosinophilic pleural effusion: case report A 68-year-old man developed eosinophilic pleural effusion (EPE) during treatment with valproic acid for agitation [indication and duration of treatment to reaction onset not stated]. The man, who had a history of Alzheimer’s dementia, was admitted for weakness, anaemia, reduced appetite, weight loss and agitation. He had been receiving treatment with valproic-acid 500 mg/day [route not stated] for 5 months, along with various other medications. On admission, CT scan and chest radiograph showed a left pleural effusion. A left thoracentesis was performed, and 350mL of exudative fluid was removed. Evaluation of the exudative fluid revealed a pH of 7.7, protein level of 3 g/dL, LDH level of 676 U/L, erythrocyte count of 12000/mL, and leucocyte count of 6190/mL with 30% eosinophils. After 3 days, a repeat CT scan revealed reduction in the original left effusion, while interval development of a large right effusion was observed. Subsequently, a right thoracentesis was performed with removal of 960mL of exudative fluid. Evaluation of the exudative fluid revealed a pH of 7.96, protein level of 4 g/dL, LDH level of 1783 U/L, erythrocyte count of 9000/mL, and leucocyte count of 1629/mL with 26% eosinophils. In view of the above findings, valproic acid-induced EPE was suspected. The man’s treatment with valproic acid was discontinued. After 3 days, chest radiography revealed resolution of the bilateral effusions. Repeat radiography was performed on day 20, day 29 and day 53 with no evidence of recurrence. The diagnosis of valproic acid-induced EPE was confirmed by the resolution of effusion after discontinuation of valproic acid. Zhang G. Valproic acid-induced eosinophilic pleural effusion: A case report and brief review. Annals of Clinical Psychiatry 32: 288-290, No. 4, Nov 2020. Available from: 803518216 URL: http://doi.org/10.12788/acp.0004
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Reactions 28 Nov 2020 No. 1832
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