Journal
PEDIATRIC NEUROLOGY
Volume 51, Issue 6, Pages 846-849Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.pediatrneurol.2014.09.007
Keywords
Fanconi syndrome; valproate; fever of unknown origin; side effects; valproate-induced Fanconi syndrome
Categories
Funding
- Research Program of Innovative Cell Biology by Innovative Technology (Cell Innovation)
- MEXT
- Ministry of Health, Labour and Welfare (MHLW) of Japan
- Kawano Masanori Memorial Public Interest Incorporated Foundation
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BACKGROUND: Valproate-induced Fanconi syndrome is a rare adverse effect of valproate. Severely disabled patients who require tube feeding are reported to be susceptible to valproate-induced Fanconi syndrome. Although most patients with valproate-induced Fanconi syndrome are asymptomatic and detected incidentally with findings such as hypophosphatemia, hypouricemia, increased urinary beta 2-microglobulin, and generalized hyperaminoaciduria, clinical symptoms such as bone fracture, fever, tachypnea, and edema have been reported. PATIENT DESCRIPTION: This 15-year-old, severely disabled, tube-fed, male patient with cytochrome oxidase deficiency had taken valproate for 3 years when he developed fever for 3 weeks. Hypophosphatemia, hypouricemia, hypokalemia, increased urinary beta 2-microglobulin, and generalized hyperaminoaciduria, as well as hypocarnitinemia, were found, indicating that he had Fanconi syndrome. Valproate was the most likely cause of Fanconi syndrome in this patient. After discontinuation of valproate, the fever resolved immediately, and the laboratory findings normalized. CONCLUSION: Valproate-induced Fanconi syndrome should be considered when individuals taking valproate develop fever of unknown origin.
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