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]