Case Report: Levetiracetam causing acute liver failure complicating post-operative management in a neurosurgical patient

Abstract

Background: Herein we report a rare case of acute liver failure due to levetiracetam, which has been considered to have an excellent safety profile with minimal hepatic side effects. Case presentation: A 55-year-old male patient presenting with sudden onset dizziness, slurring of speech and headache was operated for posterior fossa cerebellar hematoma. His post-surgical period was complicated by development of icterus with elevation of liver enzymes. After ruling out common inciting factors, it was decided to stop levetiracetam which was given prophylactically for preventing seizures owing to presence of external ventricular drain. From the next day patient had dramatic improvement in liver functions and sensorium. Conclusions: We would like to highlight this side effect that is potentially life threatening, though rare, of levetiracetam, which is very commonly used in today’s practice and fast superseding all other time-tested antiepileptics.

Assessment of the biomarkers of hepatotoxicity following carbamazepine, levetiracetam, and carbamazepine-levetiracetam adjunctive treatment in male Wistar rats

“…A significant increase in the activities of ALP, ALT, and AST in all the treatment groups, especially the CBZ treated group is an indication of liver failure and the assertion of their potential toxicity. This is in consonance with the previous findings of Hussein et al [ 66 ] and Jayashankar et al [ 67 ], who reported an acute liver failure following epilepsy treatment with LEV. However, it is worthy of note that LEV treatment whose effect was considered toxic by Jayashankar and co-worker is safer than CBZ treatment in this study.…”

Levetiracetam Liver Injury: A Benign Antiepileptic Agent?

“…2 Prior cases of drug-induced AIH note middle-aged, female predominance (78%) with positive ANA (78%–83%) and ASMA titers (45%–50%). 3,4 Biopsy findings are most often identical to AIH, with lobular inflammation, plasma cell infiltration, and interface hepatitis. 5,6…”

“…2 Prior cases of drug-induced AIH note middle-aged, female predominance (78%) with positive ANA (78%-83%) and ASMA titers (45%-50%). 3,4 Biopsy findings are most often identical to AIH, with lobular inflammation, plasma cell infiltration, and interface hepatitis. 5,6 LEV has not previously been reported to cause drug-induced AIH; however, LEV has been associated with Drug Rash with Eosinophilia and Systemic Symptoms.…”