LAUSR

Autism spectrum disorders (ASD) are frequently treated by combined therapy with psychotropic and antiepileptic agents. To treat mood disorders and aggressive behavior in ASD, a combination of valproic acid (VPA) and risperidone is used. The adverse effects of these drugs are higher in children with ASD than their peers. We report a case of autism who received VPA and risperidone, and presented with leukemialike megaloblastic anemia and pancytopenia. A 15-year-old boy was referred to our clinic with a history of pallor, petechiae, and ecchymosis. He had been taking VPA and risperidone daily for 8 years for autism and epilepsy. It was determined that he did not go to follow up regularly and his feeding was also impaired. The patient was agitated; his gingiva was hypertrophic and his teeth had large amounts of decay (Fig. 1). There were numerous petechiae and ecchymosis on the trunk and extremities. He did not have any lymphadenopathy or hepatosplenomegaly. A complete blood count showed a hemoglobin of 3.6 g/dL, a white blood cell count (WBC) of 1.4 9 10/mm, an absolute neutrophil count of 730/mm, a mean corpuscular volume (MCV) of 117 fL, and a platelet count of 8,000/mm. His serum LDH level was 1,637 U/L, and his total bilirubin level was 1.46 mg/dL with 0.66 mg/dL of it was unconjugated form. The reticulocyte count was 1.89% and the anti-globin test was negative. His serum electrolytes, liver function tests, and renal function tests were all within normal limits. His serum VPA level was 146 mg/dL (reference range 50–100). Erythrocytes were macrocytic and neutrophils were hypersegmented in the peripheral blood smear. Hyperplasia was seen in the erythroid series in his bone marrow aspiration, and immature nuclei were present. Hypersegmented neutrophils were detected. Dysplasia was seen in all series and evaluated as bone marrow with megaloblastic changes (Fig. 2). The flow cytometry test and bone marrow biopsy were sent for leukemia etiology. No phenotypic pattern could be associated with malignancy in flow cytometry and reactive erythroid hyperplasia was seen in