Levetiracetam
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Levetiracetam Skin eruptions: case report A 46-year-old woman developed a reticulated drug eruption during treatment with levetiracetam [route of administration not stated]. The woman had a seizure and started receiving phenytoin. Subsequent testing revealed a malignant brain tumour, which was removed. One day after surgery, phenytoin was replaced by levetiracetam 500mg twice daily. Twelve days later, her levetiracetam dosage was increased to 1000mg twice daily and, the next morning, she had a widespread pruritic eruption. The woman received fexofenadine and topical hydrocortisone without any improvement. She reported that diphenhydramine had alleviated the itching, but that she could not tolerate the sedative effects. She discontinued levetiracetam and presented 5 days later with some rash improvement. Phenytoin was restarted and she received chemotherapy. Physical examination showed a reticulated, macular, erythematous eruption on her abdomen, back, chest and bilaterally on the anterior of her lower extremities and mild macular erythema of her cheeks; these lesions seemed to be fading. She had intense, thin plaques in a reticular pattern on her medial upper arms, flanks and axillae. Skin biopsy revealed slight spongiotic dermatitis with superficial perivascular lymphocytic and eosinophilic infiltrates; findings were consistent with a drug eruption. Over the following 7 months, phenytoin did not control her seizures so phenytoin was replaced by topiramate and pregabalin. However, she developed drowsiness, cognitive slowing and slowness of movement. She requested a rechallenge with levetiracetam. Levetiracetam was reinitiated at 250mg every 12 hours. One week later, the woman’s levetiracetam dosage was increased to 500mg every 12 hours and, the next week, it was further increased to 750mg every 12 hours. After 3.5 weeks of levetiracetam therapy, she reported an identical, but less symptomatic rash with the same distribution. She discontinued levetiracetam and, within 1 week, her rash resolved without therapy. Beswick TC, et al. Dose-related levetiracetam-induced reticulated drug eruption. 803028075 Journal of Drugs in Dermatology 9: 409-10, No. 4, Apr 2010 - USA
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Reactions 31 Jul 2010 No. 1312
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