A case of aplastic anemia developing during anti-epileptic drug treatment for refractory epilepsy caused by chromosomal aberrations including 18q partial deletion and 4q partial trisomy

Abstract

Aplastic anemia (AA) can sometimes develop owing to the adverse effects of anti-epileptic drug use. However, the mechanisms remain unclear. We here report a case of very severe AA developed during anti-epileptic drug treatment. A 15-year-old female presented with poor complexion and a peripheral blood examination revealed severe pancytopenia. She had been administered carbamazepine, ethosuximide, sodium valproate and phenobarbital for refractory epilepsy caused by chromosome aberrations until that time. She had no histories of hematological disorders. Unfortunately, she showed no hematological improvement even when the anti-epileptic drug administration was stopped. Eventually, she was diagnosed as having very severe AA on the basis of her clinical course and laboratory findings. A few months later, she finally achieved hematological improvement with bolus methylprednisolone and prednisolone maintenance therapy. We conclude that this combination therapy appears to be effective for AA developing secondary to anti-epileptic drug use.