{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T15:23:51Z","timestamp":1791559431254,"version":"4.3.4"},"reference-count":29,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T00:00:00Z","timestamp":1786579200000},"content-version":"vor","delay-in-days":224,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Case Reports in Hematology"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:p>Myelodysplastic neoplasms (MDS) are clonal blood disorders that cause ineffective hematopoiesis, low blood counts, and a risk of progression to acute myeloid leukemia. Chemotherapy and radiation usually drive these changes, but a small set of medications, including valproic acid (VPA), can also produce reversible myelodysplastic features. We report a case of VPA\u2010induced myelodysplasia in a middle\u2010aged woman with complex neurologic and psychiatric comorbidities. The patient, with a history of paraplegia secondary to traumatic brain injury and epilepsy, was referred for evaluation of pancytopenia and significant weight loss. She had been treated with VPA for seizure prophylaxis for over a year, with dose escalation to 1000\u2009mg three times daily occurring approximately 3\u2009months prior to presentation. Laboratory evaluation revealed pancytopenia. Peripheral smear showed pseudo\u2010Pelger\u2013Hu\u00ebt cells and thrombocytopenia. Bone marrow biopsy demonstrated mild hypocellularity, erythroid hyperplasia, and dysplasia in the megakaryocytic lineage, but cytogenetic and molecular studies were negative for MDS\u2010associated mutations. We promptly stopped VPA and switched her to lacosamide. Supportive care included a PEG tube for nutrition and one packed red cell transfusion for procedure\u2010related anemia. Her blood counts improved within a week of stopping VPA and normalized completely over the following weeks, with no further cytopenia. This case shows why clinicians should recognize drug\u2010induced myelodysplasia as a reversible mimic of primary MDS. VPA\u2019s known hematologic toxicity may stem from its histone deacetylase (HDAC) inhibitor activity, which disrupts normal hematopoiesis. Clinicians should consider VPA\u2010induced myelodysplasia in patients on long\u2010term therapy who present with unexplained cytopenias. Stopping the drug early can produce full hematologic recovery and prevent unnecessary interventions.<\/jats:p>","DOI":"10.1155\/crh\/5588671","type":"journal-article","created":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T06:17:20Z","timestamp":1786688240000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Myelodysplasia From Valproic Acid Resolved by Cessation"],"prefix":"10.1155","volume":"2026","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7696-6800","authenticated-orcid":false,"given":"Chidiebube","family":"Ugwu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4398-1243","authenticated-orcid":false,"given":"Angimar 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