Valproic acid – induced Pleuro-pericardial Effusion

Background: A medication called valproic acid (VPA) is frequently used to treat a variety of neurological conditions. Common adverse effects include headache, dizziness, tremors, nausea, vomiting, diarrhea, hyperammonemia, thrombocytopenia, and hair loss. Eosinophilic pleuro-pericardial effusion is an uncommon consequence. Case report: A 66 years-old male Saudi patient, ex-smoker who had been using valproic acid for 10 years due to epilepsy presented with grade 3 Modified Medical Research Council (mMRC); gradually progressive dyspnea of 10 days duration, dry cough & atypical chest pain. A thorough examination and comprehensive studies revealed the presence of an eosinophilic pleuro-pericardial effusion. After ruling out other possible reasons, valproic acid toxicity and/or overdosage seem to be the primary cause of effusion. Modifications were made to medications. The patient was seen to be fully recovered at the end of the six-month follow-up. Conclusion: The most common explanation for valproic acid-induced eosinophilic pleuro-pericardial effusion is a medication hypersensitivity reaction. It is more likely to happen when two crucial elements are present: a high dosage of the drug and prolonged exposure.