225
ulcerwas
and
gingiva. A7-mmindurated
swollen, inflamed,
erythematous
K.L. had no
Stomatitis
Valproate-Associated
stomatitis. She
on her lower
of
history
aphthous
present
lip.
theinflam-
andwas
to brushbecauseof
reported
mation. Heracute
difficultyeating
unwilling
to
wasbelieved
ABSTRACT
beassociatedwith
poorplaque
to
swish
gingivitis
ofthe
control. The
ulcerwas
Shewas
instructed
cause
unclear.
lip
is
severe stomatitis
sodium. The
and an alu-
to
article
ofthis
to
a
case of
and
as needed with
elixir
equal parts diphenhydramine
The
spit
report
purpose
a with
for
and was
minum/magnesium antacid,
brush
but
palliative relief,
threetimes
encouraged
in
epilepsytaking divalproex
patient
pediatric
detailed
1
weeklater,
K.L. wasin obvi-
On
gently
thoroughly
perday.
to
follow-up
examinations.This
casewasreviewedwith
oral
stomatitis 18monthsafterinstitutionofdival-
severe
5-year-old
thelowerlip ulcerationwas
but
beginning
generalizedstomatitis, gingivalswelling,
muchworse, withouttissue andadditional
epithelialize,
child
developed
sodium. Cessation
ouspain. The
and
were
erythema
ofthemedicationwasassociatedwithres-
proex
were
ulcers
totalk, andwhen to doso, it was
encouraged
sloughing,
present.
A
is also
effect
stomatitis.
reviewofthe
literature
Shewasnot
with
olutionofthe
pertinent
willing
herteethclenchedto minimizelip movement.Hermother
only
thatshe
reported
to malaiseanddiscomfort. Heroralintake
is
a
rarebut
seriousadverse
Stomatitis
potentially
provided.
of
hadbeenhomefromschool
owing
a
administration.
Child Neurol
sodium
2002;17:
(J
divalproex
of
waslimitedto
straw. K.L.’s
was
presentation
atypical
drinkingthrough
225-227).
con-
disease
andmedication-inducedstomatitiswas
herpetic
sidered.
progression,
Herdose of
sodiumwas
but she
decreased,
experienced
discontin-
divalproex
no decrease in
ued. As
stomatitis until the medication was
completely
and
acid and its derivatives are
used for
sodiumwas
clonazepam
weretaken
Valproic
widely
divalproex
discontinued,
lamotrigine
treating
begun. Onfollow-up
were
dentalvisit aweek
later,
photographs
twocases
in the
acid-associatedstomatitishave
epilepsy. Only
been
of valproic
but the
and
a
in
with
concomitant
decrease
inflammationwas
and
2),
(Figure
noted,
nature of
ofthis disorder.1
reported
literature,
pleiomorphic
in
improved
functioning
eating
speaking.
stomatitis mayresult
in
under-recognition
theslowinstitution
the
a
Despite
of lamotrigine,
patientdeveloped gen-
the
eralized
macularrashoverher
blanching
entire body(excepting
palms
Case
and
and malaise. The
with etho-
was
Report
5-year-old girl
soles), fever,
lamotrigine
replaced
K.L. is
a
with
her
suxamide and
clonazepam.
after the onsetof
She had anotherdental
1 month
examination
spells;
spike
staring
electroencephalogram
revealed intermittent
and slow-wave
at
3
to
whichrevealedthatthe
wasmuch
stomatitis
generalized
250
discharges
prescribed.
symptoms,
after 1 weekoff
3.5 Hz.
staring
acid
three times
was
Her
sodium. Twohealingulcerswerenoted:
Valproic
liquid
mg
andherschool
daily
improved
onewas
divalproex
mmindiameteratthe mandibularlabialfornix
with
a
5
totooth
improved
valproic
spells stopped
performance
adjacent
mmin diameter onthe left buccal mucosa. She
ulcer and edema
acidserumconcentrationof98 /-Lg/mL, Atimelineofevent
the secondwas 1 to
3
sequencesis pro-
24;
in
notedtohavesoresinhermouth.
vided
1. Fivemonths
shewas
also continued to
a
K.L.’s
mother
later,
display
lip
Figure
(Figure 3).
Theselesionswere
andresolvedwith
to berecurrent
virusinfection
herpessimplex
2
ofthe lesions weeksafter discontinuation of
reported
thought
complete healing
sodiumwas
treatment. Her
of
sodium. She has continuedfor
7
monthswithout
stomatitis on
clonazepam
acyclovir
dosage
divalproex
divalproex
the combination of ethosuxamide 250
three times
to two
twice
and
daily
adjusted
125-mgsprinkle capsules
daily.
mg
a
serum
acid concentrationof73
Sevenmonths
0.5
twice
mg daily.
later, despite
valproic
K.L. had decreased school
to
performance (presumably owing
/-Lg/mL,
seizures), causing divalproex
additional were noted. K.L.’s mother increased
a
sodium dose increase. Fourmonths
later,
dival-
Discussion
the
staring spells
Webelieve that this
stomatitis related to dival-
she had taken this med-
patient developed
in
the
morning,
threeatmid-
sodium
tothree
sprinkle capsules
125-mg
proex
andfouratnight. Twomonthsafterthat
sodium administration.
proex
Although
K.L. sawher
increase,
dentist because of severe stomatitis. Examination
pediatric
generalized
day,
revealed
the
oral
ication for over
a
beforethe
of
year
development
lesions,
1.
of
events.
sodium
divalproex
Figure
dosing
Sequence
and
oral
Foley et al.
