A female child with generalized tonic clonic seizures, developmental
delay and on valproate therapy for 3 years presented with progressive
generalized gum enlargement. Child received valproate starting initially
at dose of 20 mg/kg/day which was later increased to about 30 mg/kg/day.
On examination there was massive gum hyper-trophy (Fig, 1) and
global developmental delay. Valproate was hence omitted and replaced
with carbamazepine, after which the gum hypertrophy stopped progressing.
|
Fig. 1. Massive gum hypertrophy. |
The most serious side effects associated with
valproate therapy are liver toxicity, thrombocytopenia and neurological
manifestations such as hallucinations, ataxia, headache, diplopia,
asterixis and dysarthria. Till date valproate induced gum hypertrophy
has not been reported. Other causes of gum hypertrophy include drug
toxicity (phenytoin, Nifedipine etc), granulomatous disease and tumor
infiltration.
Sheffali Gulati,
Anu Thukral,
Department of Pediatrics,
All India Institute of Medical Sciences,
New Delhi-110029, India.
E-mail: [email protected]