PMC6883298_01
Serial serum ALT and bilirubin levels in a 20-year-old caucasian man with new onset seizures who started VPA in October 2017.
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Follow-up lab work in December 2017 demonstrated a serum AST of 28 IU/L and ALT of 73 IU/L with total bilirubin of 0.6 mg/dl and his valproate dose was increased to 1500 mg per day due to a low serum concentration (Fig. 1).
Liver biopsy with Hematoxylin and Eosin stain (image 1) as well as Periodic Acid-Schiff stain (image 2).
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His explanted liver weighed 1332 g and demonstrated regenerative nodules with extensive necrosis and early cirrhosis on trichrome stain (Fig. 2).