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Valproic acid (VPA) is a teratogenic drug used in pregnant women for the treatment of epilepsy and mood disorders. Fetal valproate syndrome (FVS) is characterized by a number of abnormalities associated with VPA exposure in utero including neural tube defects, congenital heart defects, limb defects, genitourinary defects, brain, eye and respiratory anomalies, and abdominal wall defects. Complex cardiac defect and trigonocephaly have rarely been reported and multicystic dysplastic kidney has never been detected in FVS. We here report a female infant who was born to a mother with a history of low-dose VPA monotherapy (250 mg/day) during pregnancy and who had presented with a combination of unilateral multicystic dysplastic kidney, multicomplex cardiac defect including severe coarctation of aorta, Ebstein anomaly, secundum atrial septal defect, mesocardia along with trigonocephaly due to metopic craniosynostosis, typical facial appearance and limb defects. To our knowledge, this is the first case presented with multicystic dysplastic kidney, complex cardiac defect, trigonocephaly and other limb and facial defects because of exposure to very low-dose VPA monotherapy (250 mg/day) in utero. We conclude that VPA must be used very cautiously in pregnant women even as monotherapy and in low doses to prevent major congenital defects.

Diplopia is a condition that involves seeing double and impairs quality of life. Acute diplopia can be seen with some general medical drugs and psychotropic drugs. Selective serotonin reuptake inhibitors (SSRIs) are widely prescribed to treat a variety of psychiatric disorders. Sertraline is a relatively selective serotonin reuptake inhibitor with some dopamine reuptake inhibitor activity. This paper reports development of diplopia, a rare adverse effect of SSRI, in a 14 years old patient with major depressive disorder following use of sertraline. Clinicians should keep in mind that diplopia may occur with sertraline treatment.