Acute generalized exanthematous pustulosis secondary to levetiracetam and valproic acid use

Levy, Zachary David; Slowey, Megan; Schulder, Michael

doi:10.1016/j.ajem.2017.02.017

Cited by 8 publications

(3 citation statements)

References 8 publications

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“…Algahtani et al, [1] The patient' skin colour changed; slowly skin turned dark all over her body including face, arms, trunk and legs; mild epidermal acanthosis (increase in the thickness of the stratum spinosum of the epidermis) and generalised hyperpigmentation with Fitzpatrick skin type IV; in addition, upper dermal fibroplasia and pigmentary incontinence were noted NR NS Gupta [21] Palpable purpura and ulceration over lower extremities with itching progressing to large necrotic eschars and painful ulcers NR NS Levy et al, [22] The erythematous pustular rash started on the patient's back spreading to her scalp, face and chest…”

Section: Study Dermatologic Reactions Non-dermatological Rx Biochemical Abnormalitiesmentioning

confidence: 99%

Levetiracetam and cutaneous adverse reactions: A systematic review of descriptive studies

Rashid¹,

Rajan²,

Chhabra

et al. 2020

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Recently, there have been an increased number of reports on levetiracetam (LEV) induced cutaneous adverse drug reactions (CADRs). We aimed to identify and critically evaluate all the descriptive studies on LEV induced-CADRs and to describe the possible clinical manifestations, management, and treatment outcomes of the condition. Methodology: PubMed and grey literature databases were searched from inception to June 2019 without any restriction. We also performed a bibliographic search for additional studies. Only descriptive studies on LEVinduced CADRs were included for our review. Study selection, data abstraction and quality assessment were performed by two contributors independently and disagreements were settled through consensus or through discussion with a third reviewer. Results: Data from 24 out of 88 studies, which included 25 patients (12 female and 13 male) aged from 40 weeks to 73 years, were reviewed. Patients received between 500 mg/day to 3000 mg/day of LEV. Drug reaction with eosinophilia and systemic symptoms syndrome, Steven-Johnson syndrome, toxic epidermal necrolysis, acute generalised exanthematous pustulosis, generalised hyperpigmentation and leucocytoclastic vasculitis were observed among the included patients. Immediate cessation of LEV, providing supportive care and use of topical antihistamines and anti-inflammatory drugs appeared to be the mainstay of management, and all patients were found to have recovered. Conclusion:Clinicians should be aware of the possible CADRs induced by LEV to avoid the development of a potentially fatal condition. Immediate withdrawal of the drug and supporting care seem to be effective in the management of the CADRs. Registration number: International Prospective Register for Systematic Reviews (PROSPERO) number CRD42019141002.

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Section: Study Dermatologic Reactions Non-dermatological Rx Biochemical Abnormalitiesmentioning

confidence: 99%

Levetiracetam and cutaneous adverse reactions: A systematic review of descriptive studies

Rashid¹,

Rajan²,

Chhabra

et al. 2020

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“…3,4 These reactions are mostly delayed-type reactions as SJS, TEN, and acute generalized exanthematous pustulosis (AGEP) in adults and as DRESS in a child. 1,3,[4][5][6] A turkish child who developed an immediate-type reaction due to levetiracetam use was reported before our case. 7 This case was a newborn and anaphylactic shock was reported when levetiracetam was administered due to treatment-resistant seizures.…”

Section: Discussionmentioning

confidence: 99%

Anaphylaxis to levetiracetam in an adolescent: a very rare occurence

et al. 2021

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Antiepileptic drug (AED)-induced hypersensitivity reactions(HSR) which are reported to be more common in children, present with a variety of clinical manifestations ranging from benign maculopapular exanthems to severe delayed reactions such as Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), Drug Reaction with Eosinophilia and Systemic Symptoms(DRESS) and also organ-specific disease such as agranulocytosis and drug-induced liver injury. 1 Immediate-type HSRs such as urticaria/ angioedema or anaphylaxis are very rare with AEDs. Delayed reactions are more commonly seen with aromatic AEDs like phenytoin and carbamazepine than the new generation or non-aromatic AEDs. 1 Levetiracetam is an increasingly used new non-aromatic AEDs and reported to have a safer tolerability profile in daily practice. 2 Here, we report an adolescent case of anaphylaxis due to levetiracetam, in order to point out that new AEDs can result in HSRs and also, severe immediate reactions should be expected Case ReportA 15-year-old girl with no previous diagnosis of epilepsy presented to the pediatric emergency department with a history of two seizures in the same day. Later in the emergency department, the patient experienced another seizure with jaw-locking, nystagmus, spasms in legs and arms

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“…Antiarrhythmics, such as amiodarone and propafenone, and antihypertensives, including diltiazem, hydralazine, and ranolazine have also been reported [ 123 – 127 ]. Anticonvulsants, including valproic acid and levetiracetam, and antipsychotics, including cariprazine, haloperidol, olanzapine, and quetiapine, have been implicated in AGEP, as have opioids, including codeine and dextromethorphan [ 25 , 128 – 137 ]. Hormonal therapies, including letrozole and mifepristone have been implicated in AGEP [ 92 , 138 , 139 ].…”

Section: Pathogenesismentioning

confidence: 99%

Acute Generalized Exanthematous Pustulosis: Clinical Features, Differential Diagnosis, and Management

et al. 2023

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Acute generalized exanthematous pustulosis (AGEP) is a rare, acute, severe cutaneous adverse reaction mainly attributed to drugs, although other triggers, including infections, vaccinations, ingestion of various substances, and spider bites, have also been described. AGEP is characterized by the development of edema and erythema followed by the eruption of multiple punctate, non-follicular, sterile pustules and subsequent desquamation. AGEP typically has a rapid onset and prompt resolution within a few weeks. The differential diagnoses for AGEP are broad and include infectious, inflammatory, and drug-induced etiologies. Diagnosis of AGEP depends on both clinical and histologic criteria, as cases of overlap with other disease processes have been reported. Management includes removal of the offending drug or treatment of the underlying cause, if necessary, and supportive care, as AGEP is a self-limited disease. This review aims to provide an overview and update on the epidemiology, pathogenesis, reported precipitating factors, differentials, diagnosis, and management of AGEP.

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Acute generalized exanthematous pustulosis secondary to levetiracetam and valproic acid use

Cited by 8 publications

References 8 publications

Levetiracetam and cutaneous adverse reactions: A systematic review of descriptive studies

Levetiracetam and cutaneous adverse reactions: A systematic review of descriptive studies

Anaphylaxis to levetiracetam in an adolescent: a very rare occurence

Acute Generalized Exanthematous Pustulosis: Clinical Features, Differential Diagnosis, and Management

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