title: Rare Red Rashes: A Case Report of Levetiracetam-Induced Cutaneous Reaction and Review of the Literature.
abstract: Cutaneous reactions secondary to medications are rare but can be serious events resulting in morbidity and mortality and can be caused by anticonvulsant medications. Levetiracetam has been considered relatively safe compared with other antiepileptics with regard to skin eruptions. We report a case of a cutaneous reaction secondary to levetiracetam. A 64-year-old man presented to the hospital with an altered mental status and aphasia. Imaging revealed a left basal ganglia mass. A biopsy of the lesion was obtained, and levetiracetam was started at 500 mg intravenously twice a day for seizure prophylaxis. After 13 doses, the patient developed a diffuse, erythematous, warm, blanching, morbilliform rash. Levetiracetam was discontinued, and methylprednisolone was started. After 4 days, the rash dissipated. Levetiracetam is an antiepileptic medication that has an unknown mechanism of action. To date, there are only 4 cases reported involving skin reactions from levetiracetam. Two of the cases were classified as Stevens-Johnson Syndrome: 1 as toxic epidermal necrolysis and 1 as erythema multiforme. Our case was classified as a morbilliform rash. A Naranjo score of 7 suggested a probable cause for a levetiracetam-induced skin reaction. Antiepileptic medications are used in certain cases to prevent seizures in patients with central nervous system tumors. Although levetiracetam seems to have fewer side effects than the traditional antiepileptic medications, it is important for the healthcare provider to continuously evaluate the need for all medications and discontinue unneeded ones to help avoid potential medication adverse effects.
authors.affiliation: 1College of Osteopathic Medicine, Michigan State University, East Lansing, MI; 2College of Pharmacy, Ferris State University, Big Rapids, MI; 3College of Pharmacy, Ferris State University, Big Rapids, MI; and 4Department of Internal Medicine, Western Michigan University School of Medicine, Kalamazoo, MI.
authors.forename: Ryan T
authors.initials: RT
authors.lastname: Jones
authors.forename: William
authors.initials: W
authors.lastname: Evans
authors.forename: Tracey L
authors.initials: TL
authors.lastname: Mersfelder
authors.forename: Kevin
authors.initials: K
authors.lastname: Kavanaugh
mesh_terms: D000927:Anticonvulsants / Q000009:adverse effects*; D003875:Drug Eruptions / Q000209:etiology*; D005076:Exanthema / Q000139:chemically induced*; D006801:Humans; D000077287:Levetiracetam; D008297:Male; D008875:Middle Aged; D010889:Piracetam / Q000009:adverse effects / Q000031:analogs & derivatives*; D012640:Seizures / Q000517:prevention & control
chemical_list: D000927:Anticonvulsants; D000077287:Levetiracetam; D010889:Piracetam