Valproic acid triggers acute rhabdomyolysis in a patient with carnitine palmitoyltransferase type II deficiency

A 47-year-old man suffering from a bipolar disorder and intermittent myoglo binuria presented with acute rhabdomyolysis with renal failure after starti ng therapy with valproic acid. On morphological examination, skeletal muscl e revealed increased lipid storage. Biochemically, decreased enzyme activit y of carnitine palmitoyltransferase (CPT) type II with carnitine levels in the lower limit was found. Genetic analysis detected the common Ser113Leu s ubstitution on one allele of the CPT2 gene. We conclude that valproic acid should be avoided in patients with CPT type II deficiency. (C) 2001 Elsevie r Science B.V. All rights reserved.