Letter to the Editor
Pulmonary eosinophilia associated with valproic acid
Eosinofilia pulmonar asociada a ácido valproico
Read
25
Timeswas read the article
8
Total PDF
17
Total HTML
Share statistics
array:24 [ "pii" => "S2387020615002600" "issn" => "23870206" "doi" => "10.1016/j.medcle.2014.07.007" "estado" => "S300" "fechaPublicacion" => "2015-06-08" "aid" => "3089" "copyright" => "Elsevier España, S.L.U.. All rights reserved" "copyrightAnyo" => "2014" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Med Clin. 2015;144:527-8" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 25 "formatos" => array:2 [ "HTML" => 17 "PDF" => 8 ] ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0025775314005879" "issn" => "00257753" "doi" => "10.1016/j.medcli.2014.07.025" "estado" => "S300" "fechaPublicacion" => "2015-06-08" "aid" => "3089" "copyright" => "Elsevier España, S.L.U." "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Med Clin. 2015;144:527-8" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 113 "formatos" => array:2 [ "HTML" => 94 "PDF" => 19 ] ] "es" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Carta al Editor</span>" "titulo" => "Eosinofilia pulmonar asociada a ácido valproico" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "527" "paginaFinal" => "528" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Pulmonary eosinophilia associated with valproic acid" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Sonia María San Miguel López de Uralde, Marta Prieto Peraita, Emilio Javier Blanco Bengoechea" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Sonia María" "apellidos" => "San Miguel López de Uralde" ] 1 => array:2 [ "nombre" => "Marta" "apellidos" => "Prieto Peraita" ] 2 => array:2 [ "nombre" => "Emilio Javier" "apellidos" => "Blanco Bengoechea" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2387020615002600" "doi" => "10.1016/j.medcle.2014.07.007" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020615002600?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775314005879?idApp=UINPBA00004N" "url" => "/00257753/0000014400000011/v2_201505100049/S0025775314005879/v2_201505100049/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2387020615002582" "issn" => "23870206" "doi" => "10.1016/j.medcle.2014.09.006" "estado" => "S300" "fechaPublicacion" => "2015-06-08" "aid" => "3113" "copyright" => "Elsevier España, S.L.U." "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Med Clin. 2015;144:528" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 52 "formatos" => array:2 [ "HTML" => 29 "PDF" => 23 ] ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Idiopathic perilobular granulomatous mastitis: Diagnostic and therapeutic considerations" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "528" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Mastitis granulomatosa perilobulillar idiopática: aspectos diagnósticos y terapéuticos" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Juana Sanint, Antonio Mariscal Martínez, Joan Francesc Julián Ibáñez, Alejandro Olivé Marqués" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Juana" "apellidos" => "Sanint" ] 1 => array:2 [ "nombre" => "Antonio" "apellidos" => "Mariscal Martínez" ] 2 => array:2 [ "nombre" => "Joan Francesc" "apellidos" => "Julián Ibáñez" ] 3 => array:2 [ "nombre" => "Alejandro" "apellidos" => "Olivé Marqués" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0025775314006708" "doi" => "10.1016/j.medcli.2014.09.005" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775314006708?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020615002582?idApp=UINPBA00004N" "url" => "/23870206/0000014400000011/v1_201602060036/S2387020615002582/v1_201602060036/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2387020615002594" "issn" => "23870206" "doi" => "10.1016/j.medcle.2015.12.008" "estado" => "S300" "fechaPublicacion" => "2015-06-08" "aid" => "3100" "copyright" => "Elsevier España, S.L.U." "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Med Clin. 2015;144:526-7" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 29 "formatos" => array:2 [ "HTML" => 21 "PDF" => 8 ] ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Usefulness of measuring cardiovascular risk at 30 years and vascular age" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "526" "paginaFinal" => "527" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Utilidad del cálculo del riesgo cardiovascular a 30 años y de la edad vascular" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "José I. Cuende" "autores" => array:1 [ 0 => array:2 [ "nombre" => "José I." "apellidos" => "Cuende" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0025775314006368" "doi" => "10.1016/j.medcli.2014.07.030" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775314006368?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020615002594?idApp=UINPBA00004N" "url" => "/23870206/0000014400000011/v1_201602060036/S2387020615002594/v1_201602060036/en/main.assets" ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Pulmonary eosinophilia associated with valproic acid" "tieneTextoCompleto" => true "saludo" => "<span class="elsevierStyleItalic">Dear Editor</span>," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "527" "paginaFinal" => "528" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Sonia María San Miguel López de Uralde, Marta Prieto Peraita, Emilio Javier Blanco Bengoechea" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Sonia María" "apellidos" => "San Miguel López de Uralde" "email" => array:1 [ 0 => "soniamaria.sanmiguellopezdeuralde@osakidetza.net" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Marta" "apellidos" => "Prieto Peraita" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Emilio Javier" "apellidos" => "Blanco Bengoechea" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicio de Medicina Interna RSMB, Hospital Psiquiátrico de Zaldibar, Zaldibar, Vizcaya, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Farmacia RSMB, Hospital Psiquiátrico de Zaldibar, Zaldibar, Vizcaya, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Psiquiatría RSMB, Hospital Psiquiátrico de Zaldibar, Zaldibar, Vizcaya, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Eosinofilia pulmonar asociada a ácido valproico" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Few cases of eosinophilic pleural effusion associated with valproic acid have been described in the medical literature. We present the case of a female patient who developed eosinophilic pleural effusion, with bilateral pulmonary infiltrates.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The patient is a 39-year old female, who had smoked one pack of cigarettes/day (for the last 4 weeks). Previously, she had been a former smoker from 20 years of age, with a cumulative index of 4 packs of cigarettes/year.</p><p id="par0015" class="elsevierStylePara elsevierViewall">She was admitted to the Psychiatric Hospital for stabilisation after several serious suicide attempts. She was diagnosed with an adjustment disorder and symptoms of anxiety and depression and treated with lactulose, clonazepam (5<span class="elsevierStyleHsp" style=""></span>mg/day), valproic acid (500<span class="elsevierStyleHsp" style=""></span>mg/12<span class="elsevierStyleHsp" style=""></span>h) and lormetazepam (rescue therapy). The month before, during her previous admission to the Acute Psychiatric Unit, treatment with valproic acid as an impulse modulator had been started, since the patient also had a family history of bipolar disorder.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Over the course of 48<span class="elsevierStyleHsp" style=""></span>h, the patient developed the appearance of symptoms of slowly progressive dyspnoea with acute respiratory failure and few previous signs of infection. Consequently, she was referred to the aforementioned hospital.</p><p id="par0025" class="elsevierStylePara elsevierViewall">On admission to Pneumology, the patient had bilateral pulmonary infiltrates with bilateral pleural effusion, and progressive respiratory failure which, added to the appearance of high fever during the first 24<span class="elsevierStyleHsp" style=""></span>h, supported the broad-spectrum antibiotic treatment that was administered from the beginning. Analytical tests showed an increase in C-reactive protein, left shift leukocytosis, a negative urinary antigen test for pneumococcus and <span class="elsevierStyleItalic">Legionella</span>, and negative serologies for <span class="elsevierStyleItalic">Mycoplasma</span>, <span class="elsevierStyleItalic">Legionella</span>, <span class="elsevierStyleItalic">Coxiella</span> and <span class="elsevierStyleItalic">Chlamydophila</span>.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Due to the presence of bilateral pleural effusion, two diagnostic thoracocentesis were performed, in which liquid with eosinophilic exudate characteristics (11% and 16% of eosinophils, respectively) was evacuated. In both thoracocentesis, we also performed an ADA (11 and 40, respectively), cultures for aerobic and anaerobic organisms, and microbacteria (all negative), plus cytologies, which also proved an eosinophilic inflammatory infiltrate without malignant characteristics. In the same way, sputum cultures, pleural liquid and blood cultures came back negative. Bronchoalveolar lavage was performed, which also informed about 36% of the eosinophils (cultures and cytologies were also negative).</p><p id="par0035" class="elsevierStylePara elsevierViewall">On the basis of these findings, autoimmune disease was discarded (negative RF, ANA and ANCA) and a serous precipitin study was requested, which was also negative.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Antibiotic treatment was continued, valproic acid was suspended and high doses of corticotherapy were added. The patient experienced a rapid clinical and radiological improvement, allowing the withdrawal of oxygen therapy and her discharge from the hospital.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Today, the patient, still on corticotherapy, remains asymptomatic and the previously described radiological alterations have been completely resolved.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Having discarded other causes of eosinophilic pleural effusion, and in view of clinical progress, we conclude that valproic acid was responsible for the effusion and pulmonary infiltrates, which were definitively resolved. This adverse reaction reaches a score of 6 in Naranjo's algorithm, which allows us to define it as possible. All the above is reinforced by a systematic search of PubMed to seek out titles published between 2000 and 2014 that matched the terms “<span class="elsevierStyleItalic">valproic acid</span>” with “<span class="elsevierStyleItalic">adverse drug reactions</span>” or “<span class="elsevierStyleItalic">eosinophilic pneumonia</span>” or “<span class="elsevierStyleItalic">drug eosinophilic reaction</span>.” Our suspicion of adverse reaction was communicated to the Basque Pharmacovigilance Centre by the yellow card scheme.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Several cases have been described in which pleural effusion<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1–3</span></a> with eosinophilic prevalence has been associated with valproic acid treatment. Most of them had no associated pulmonary involvement, as distinct to our case. In all the cases in which pulmonary infiltrates are described, these arise from a pulmonary haemorrhage<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> or a pneumonitis<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> in the context of a DRESS syndrome with organic involvement.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Eosinophilic pleural effusion associated with valproic acid can be present with peripheral eosinophilia,<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> which also disappears after the withdrawal of the drug. The presence of fever and leukocytosis with peripheral deviations does not discount valproic acid as responsible for the symptoms, even though it initially leans towards an infectious origin. The mechanism<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> by which valproic acid can cause the appearance of eosinophilic pleural effusion is unknown, but it can happen at any time during treatment, not necessarily at the onset or with a modification of the dose, and with any level of dose, not necessarily a high dosage.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: San Miguel López de Uralde SM, Prieto Peraita M, Blanco Bengoechea EJ. Eosinofilia pulmonar asociada a ácido valproico. Med Clin (Barc). 2015;144:527–528.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sodium valproate as a cause of recurrent transudative pleural effusion: a case report" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "S. Tryfon" 1 => "M. Saroglou" 2 => "K. Kazanas" 3 => "C. Mermigkis" 4 => "K. Psathakis" 5 => "N. Galanis" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/1752-1947-3-51" "Revista" => array:5 [ "tituloSerie" => "J Med Case Rep" "fecha" => "2009" "volumen" => "3" "paginaInicial" => "51" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19203367" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0035" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Valproic acid-induced eosinophilic pleural effusion: a case report and review of the literature" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "W. Bullington" 1 => "S.A. Sahn" 2 => "M.A. Judson" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/MAJ.0b013e31805339ae" "Revista" => array:6 [ "tituloSerie" => "Am J Med Sci" "fecha" => "2007" "volumen" => "333" "paginaInicial" => "290" "paginaFinal" => "292" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17505171" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0040" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Valproic acid-induced eosinophilic pleural effusion: a case report and review of the literature" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "Z. Kamenetsky" 1 => "N. Da’as" 2 => "Y. Esayag" 3 => "Y. Kleinman" 4 => "N. Samuels" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/NRL.0b013e31823d7a6d" "Revista" => array:6 [ "tituloSerie" => "Neurologist" "fecha" => "2012" "volumen" => "18" "paginaInicial" => "39" "paginaFinal" => "40" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22217614" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0045" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Adverse drug reactions induced by valproic acid" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "R.M. Nanau" 1 => "M.G. Neuman" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.clinbiochem.2013.06.012" "Revista" => array:6 [ "tituloSerie" => "Clin Biochem" "fecha" => "2013" "volumen" => "46" "paginaInicial" => "1323" "paginaFinal" => "1338" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23792104" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Successful treatment of antiepileptic drug-induced DRESS syndrome with pulse methylprednisolone" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "C. Kocaoglu" 1 => "C. Cilasun" 2 => "E.S. Solak" 3 => "G.S. Kurtipek" 4 => "S. Arslan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1155/2013/928910" "Revista" => array:5 [ "tituloSerie" => "Case Rep Pediatr" "fecha" => "2013" "volumen" => "2013" "paginaInicial" => "928910" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23691411" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23870206/0000014400000011/v1_201602060036/S2387020615002600/v1_201602060036/en/main.assets" "Apartado" => array:4 [ "identificador" => "43309" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23870206/0000014400000011/v1_201602060036/S2387020615002600/v1_201602060036/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020615002600?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2017 October | 2 | 1 | 3 |
| 2017 September | 3 | 0 | 3 |
| 2017 August | 3 | 1 | 4 |
| 2017 July | 3 | 4 | 7 |
| 2017 June | 6 | 1 | 7 |
| 2017 May | 0 | 1 | 1 |
