Hepatitis tóxica secundaria al tratamiento con ácido valproicodiagnóstico diferencial; a propósito de un caso

Resumen

The case is presented of a 70 year-old male with bipolar affective disorder, who was admitted to the psychiatric inpatient unit due to a mania episode after stopping taking his usual treatment. Nine days after the reintroduction of the treatment (quetiapine and valproic acid), the patient started to suffer symptoms compatible with toxic liver disease, with epigastric pain and general discomfort followed by voiding a dark urine, sudden elevation of liver enzymes, and a fever of 39.3°C. After being assessed by Internal Medicine and Gastroenterology department, both drugs were removed. Several physical examinations were performed. Finally, blood cultures were positive for E. coli, for which antibiotic treatment was started. The patient improved with the discontinuation of drugs and the antibiotic treatment. The signs and symptoms decreased and liver enzymes began to descend gradually until they returned to normal. In this case, it may be concluded, due to the presentation and the evolution of the symptoms, that the most likely cause of hepatitis was infection. However, we want to point out the importance of performing an adequate differential diagnosis of causes of hepatotoxicity.