Levetiracetam induced drug reaction with eosinophilia and systemic symptom syndrome

Dar, Waseem; Sofi, Najeeb Ullah; Latief, Muzamil; Dar, Imtiyaz Ahmad; Kasana, Basharat

doi:10.4103/0019-5154.177777

Cited by 15 publications

(14 citation statements)

References 15 publications

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“…We have also found that VPA and LEV more commonly caused SCARs in the Korean population. Hypersensitivity reactions have been rarely observed in patients taking non-aromatic AEDs, such as VPA, LEV, and vigabatrin 8282930. It has been reported that the incidence of LTG-induced hypersensitivity was increased when VPA and/or other AEDs are administered concurrently 31.…”

Section: Discussionmentioning

confidence: 99%

Severe Cutaneous Adverse Reactions to Antiepileptic Drugs: A Nationwide Registry-Based Study in Korea

Park

Kang

et al. 2019

Allergy Asthma Immunol Res

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Purpose Severe cutaneous adverse reactions (SCARs), including Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and drug reaction with eosinophilia and systemic symptoms (DRESS) to antiepileptic drug (AED), are rare, but result in significant morbidity and mortality. We investigated the major culprit drugs, clinical characteristics, and clinical course and outcomes of AED-induced SCARs using a nationwide registry in Korea. Methods A total of 161 patients with AED-induced SCARs from 28 referral hospitals were analyzed. The causative AEDs, clinical characteristics, organ involvements, details of treatment, and outcomes were evaluated. We compared the clinical and laboratory parameters between SJS/TEN and DRESS according to the leading causative drugs. We further determined risk factors for prolonged hospitalization in AED-induced SCARs. Results Carbamazepine and lamotrigine were the most common culprit drugs causing SCARs. Valproic acid and levetiracetam also emerged as the major causative agents. The disease duration and hospital stay in carbamazepine-induced SJS/TEN were shorter than those in other AEDs ( P < 0.05, respectively). In younger patients, lamotrigine caused higher incidences of DRESS than other drugs ( P = 0.045). Carbamazepine, the most common culprit drug for SCARs, was associated with a favorable outcome related with prolonged hospitalization in SJS (odds ratio, 0.12; 95% confidence interval, 0.02-0.63, P = 0.12), and thrombocytopenia was found to be a risk factor for prolonged hospitalization in DRESS. Conclusion This was the first large-scale epidemiological study of AED-induced SCARs in Korea. Valproic acid and levetiracetam were the significant emerging AEDs causing SCARs in addition to the well-known offending AEDs such as carbamazepine and lamotrigine. Carbamazepine was associated with reduced hospitalization, but thrombocytopenia was a risk factor for prolonged hospitalization. Our results suggest that the clinical characteristics and clinical courses of AED-induced SCARs might vary according to the individual AEDs.

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Section: Discussionmentioning

confidence: 99%

Severe Cutaneous Adverse Reactions to Antiepileptic Drugs: A Nationwide Registry-Based Study in Korea

Park

Kang

et al. 2019

Allergy Asthma Immunol Res

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“…Abdomen associated with moderate oedema Leucocytosis Dar et al, [12] The erythematous maculopapular rash was seen predominantly on the face, chest, trunk, back, upper limbs and the proximal portion of lower limb Cervical and axillary lymphadenopathy NS Bhoi et al, [18] Pt 1 -maculopapular rash affecting the mucous membrane on more than 70% BSA; Pt 2morbilliform pruritic rash [11] Erythematous rash and urticaria from the scalp, face and entire body NR Metabolic acidosis, hypotensive…”

Section: Study Dermatologic Reactions Non-dermatological Rx Biochemical Abnormalitiesmentioning

confidence: 99%

“…DRESS has an annual incidence rate of 1 in 10 cases and is more common among the African American males, believed to be due to vitamin D deficiency which causes inflammation [12,13]. Human leucocyte antigen (HLA) alleles such as HLA-B*15:02 and HLA-A*31:01 are associated with SJS induced by VPA and CBZ [6].…”

Section: Introductionmentioning

confidence: 99%

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

Rashid¹,

Rajan²,

Chhabra

et al. 2020

Seizure

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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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“…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: 57%

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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Levetiracetam induced drug reaction with eosinophilia and systemic symptom syndrome

Cited by 15 publications

References 15 publications

Severe Cutaneous Adverse Reactions to Antiepileptic Drugs: A Nationwide Registry-Based Study in Korea

Severe Cutaneous Adverse Reactions to Antiepileptic Drugs: A Nationwide Registry-Based Study in Korea

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

Anaphylaxis to levetiracetam in an adolescent: a very rare occurence

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