Hello

You are 37 and have been tested positive for HIV but you are not on medicines for this. You are currently on Lexapro (Escitalopram) 20 mg per day and Depakote (Divalproate sodium) 1000 mg per day. You have developed sudden onset itch all over your body and more on hands and feet. You took antihistaminic medicine (benadryl) but no improvement. You stomach is bloated and edema over hands and feet is present.

These symptoms may occur in two causes-

First thing is hypersensitivity reaction occurring due to drugs. Although it can happen with any drugs- sodium valproate may be a cause (although it is rare with both drugs). It can occur during any stage of therapy in susceptible persons. It usually presents with itching and redness with rashes all over body. Edema, difficulty in breathing, fullness of abdomen is also observed. Management includes immediately stopping the drug to prevent severe fixed drug eruptions. Application of any soothing agent like Lecto calamine lotion or steroid cream like betamethasone cream will help to give symptomatic relief in itching.

Second thing may be Thrombocytopenia occurring due to Valproate sodium. Thrombocytopenia is decreased platelet counts. It is a side effect with valproate therapy. In thrombocytopenia itching, redness (bruising) and sometimes edema may be seen.

Both the instances are drug associated effects. Therefore I urge you to report back to your treating doctor. You may be advised to go for a Complete Hemogram to check for any fall in platelet count (Normal 0000-0000). Besides that drug changes may apply.

Hope this answers your query. If you have more questions you can ask again.

Thanks
Dr. Seikhoo Bishnoi MD
(Consultant Psychiatrist)

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