Valproate-induced hyperammonaemia superimposed upon severe neuropsychiatric lupus: a case report and review of the literature
Identifieur interne : 001321 ( Main/Exploration ); précédent : 001320; suivant : 001322Valproate-induced hyperammonaemia superimposed upon severe neuropsychiatric lupus: a case report and review of the literature
Auteurs : Estee Chan [Nouvelle-Zélande] ; Fiona Mcqueen [Nouvelle-Zélande]Source :
- Clinical Rheumatology [ 0770-3198 ] ; 2013-03-01.
English descriptors
Abstract
Abstract: This paper presents a case of systemic lupus erythematosus (SLE) with neuropsychiatric features, where the outcome was influenced by the development of hyperammonaemia, probably induced by sodium valproate. A case of severe SLE occurring in a 20-year-old Maori girl is described. Her disease had been characterised by neuropsychiatric features for several years, culminating in persistent seizure activity at the time of her final presentation. Her management with anticonvulsants was complicated by the development of intractable hyperammonaemia which contributed to irreversible clinical deterioration. We have reviewed the English literature for reports of valproate-related hyperammonaemia which has often been described in the setting of seizure and mood disorders. This is the first case where it has been reported, superimposed upon severe neuropsychiatric SLE (NP-SLE). The mechanism by which valproate induces hyperammonaemia remains incompletely understood but is likely to relate to the urea cycle. Under normal metabolic conditions, acyl-CoA is transported into the mitochondria via a carnitine transport system. It is then converted to acetyl-CoA via β-oxidation and eventually to N-acetyl glutamate. This pathway can be interrupted by the introduction of sodium valproate, leading to a reduction of free coenzyme A, acetyl-CoA and carnitine, and resulting in the decreased availability of cofactors necessary for the function of the urea cycle. As this is the primary means of ammonia metabolism, serious elevation in serum ammonia levels may occur in patients on this anticonvulsant medication. In this patient with active NP-SLE, the combined autoimmune and metabolic brain insult contributed to a fatal outcome.
Url:
DOI: 10.1007/s10067-012-2150-x
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<record><TEI wicri:istexFullTextTei="biblStruct"><teiHeader><fileDesc><titleStmt><title xml:lang="en">Valproate-induced hyperammonaemia superimposed upon severe neuropsychiatric lupus: a case report and review of the literature</title><author><name sortKey="Chan, Estee" sort="Chan, Estee" uniqKey="Chan E" first="Estee" last="Chan">Estee Chan</name></author><author><name sortKey="Mcqueen, Fiona" sort="Mcqueen, Fiona" uniqKey="Mcqueen F" first="Fiona" last="Mcqueen">Fiona Mcqueen</name></author></titleStmt><publicationStmt><idno type="wicri:source">ISTEX</idno><idno type="RBID">ISTEX:34F4459AADFA5B0BEF62675E32776718CB54BC67</idno><date when="2012" year="2012">2012</date><idno type="doi">10.1007/s10067-012-2150-x</idno><idno type="url">https://api.istex.fr/ark:/67375/VQC-41RJD0X9-C/fulltext.pdf</idno><idno type="wicri:Area/Istex/Corpus">000E14</idno><idno type="wicri:explorRef" wicri:stream="Istex" wicri:step="Corpus" wicri:corpus="ISTEX">000E14</idno><idno type="wicri:Area/Istex/Curation">000E14</idno><idno type="wicri:Area/Istex/Checkpoint">000330</idno><idno type="wicri:explorRef" wicri:stream="Istex" wicri:step="Checkpoint">000330</idno><idno type="wicri:doubleKey">0770-3198:2012:Chan E:valproate:induced:hyperammonaemia</idno><idno type="wicri:Area/Main/Merge">001322</idno><idno type="wicri:Area/Main/Curation">001321</idno><idno type="wicri:Area/Main/Exploration">001321</idno></publicationStmt><sourceDesc><biblStruct><analytic><title level="a" type="main" xml:lang="en">Valproate-induced hyperammonaemia superimposed upon severe neuropsychiatric lupus: a case report and review of the literature</title><author><name sortKey="Chan, Estee" sort="Chan, Estee" uniqKey="Chan E" first="Estee" last="Chan">Estee Chan</name><affiliation wicri:level="1"><country xml:lang="fr">Nouvelle-Zélande</country><wicri:regionArea>Department of Rheumatology, Greenlane Clinical Centre, Auckland District Health Board, Private Bag 92024, Auckland Mail Centre, 1142, Auckland</wicri:regionArea><wicri:noRegion>Auckland</wicri:noRegion></affiliation><affiliation wicri:level="1"><country wicri:rule="url">Nouvelle-Zélande</country></affiliation></author><author><name sortKey="Mcqueen, Fiona" sort="Mcqueen, Fiona" uniqKey="Mcqueen F" first="Fiona" last="Mcqueen">Fiona Mcqueen</name><affiliation wicri:level="1"><country xml:lang="fr">Nouvelle-Zélande</country><wicri:regionArea>Department of Rheumatology, Greenlane Clinical Centre, Auckland District Health Board, Private Bag 92024, Auckland Mail Centre, 1142, Auckland</wicri:regionArea><wicri:noRegion>Auckland</wicri:noRegion></affiliation><affiliation wicri:level="1"><country xml:lang="fr">Nouvelle-Zélande</country><wicri:regionArea>Department of Molecular Medicine and Pathology, University of Auckland, Auckland</wicri:regionArea><wicri:noRegion>Auckland</wicri:noRegion></affiliation></author></analytic><monogr></monogr><series><title level="j">Clinical Rheumatology</title><title level="j" type="sub">Journal of the International League of Associations for Rheumatology</title><title level="j" type="abbrev">Clin Rheumatol</title><idno type="ISSN">0770-3198</idno><idno type="eISSN">1434-9949</idno><imprint><publisher>Springer-Verlag</publisher><pubPlace>London</pubPlace><date type="published" when="2013-03-01">2013-03-01</date><biblScope unit="volume">32</biblScope><biblScope unit="issue">3</biblScope><biblScope unit="page" from="403">403</biblScope><biblScope unit="page" to="407">407</biblScope></imprint><idno type="ISSN">0770-3198</idno></series></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0770-3198</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Anticonvulsants</term><term>Hyperammonaemia</term><term>Sodium valproate</term><term>Systemic lupus erythematosus</term></keywords></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Abstract: This paper presents a case of systemic lupus erythematosus (SLE) with neuropsychiatric features, where the outcome was influenced by the development of hyperammonaemia, probably induced by sodium valproate. A case of severe SLE occurring in a 20-year-old Maori girl is described. Her disease had been characterised by neuropsychiatric features for several years, culminating in persistent seizure activity at the time of her final presentation. Her management with anticonvulsants was complicated by the development of intractable hyperammonaemia which contributed to irreversible clinical deterioration. We have reviewed the English literature for reports of valproate-related hyperammonaemia which has often been described in the setting of seizure and mood disorders. This is the first case where it has been reported, superimposed upon severe neuropsychiatric SLE (NP-SLE). The mechanism by which valproate induces hyperammonaemia remains incompletely understood but is likely to relate to the urea cycle. Under normal metabolic conditions, acyl-CoA is transported into the mitochondria via a carnitine transport system. It is then converted to acetyl-CoA via β-oxidation and eventually to N-acetyl glutamate. This pathway can be interrupted by the introduction of sodium valproate, leading to a reduction of free coenzyme A, acetyl-CoA and carnitine, and resulting in the decreased availability of cofactors necessary for the function of the urea cycle. As this is the primary means of ammonia metabolism, serious elevation in serum ammonia levels may occur in patients on this anticonvulsant medication. In this patient with active NP-SLE, the combined autoimmune and metabolic brain insult contributed to a fatal outcome.</div></front></TEI><affiliations><list><country><li>Nouvelle-Zélande</li></country></list><tree><country name="Nouvelle-Zélande"><noRegion><name sortKey="Chan, Estee" sort="Chan, Estee" uniqKey="Chan E" first="Estee" last="Chan">Estee Chan</name></noRegion><name sortKey="Chan, Estee" sort="Chan, Estee" uniqKey="Chan E" first="Estee" last="Chan">Estee Chan</name><name sortKey="Mcqueen, Fiona" sort="Mcqueen, Fiona" uniqKey="Mcqueen F" first="Fiona" last="Mcqueen">Fiona Mcqueen</name><name sortKey="Mcqueen, Fiona" sort="Mcqueen, Fiona" uniqKey="Mcqueen F" first="Fiona" last="Mcqueen">Fiona Mcqueen</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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