Atypical, Levetiracetam-induced Hypersensitivity Syndrome Complicated by Fulminant Liver Failure in a Patient Undergoing Hemodialysis

• Published in: Internal Medicine Vol. 61; no. 19; pp. 2911 - 2916
• Main Authors: Sato, Hirotaka, Takase, Kentaro, Harada, Aiko, Ozono, Iori, Kodama, Yasuhide, Ishitobi, Tomoko, Imada, Toshihiro, Ohnuma, Hideyuki, Kin, Seikon
• Format: Journal Article
• Language: English
• Published: Japan The Japanese Society of Internal Medicine 01.10.2022; Japan Science and Technology Agency
• Subjects: Case Report; drug induced hypersensitivity; Etiracetam; Fever; Hemodialysis; Hypersensitivity; Internal medicine; Leukopenia; levetiracetam; Liver failure; Patients; Prednisolone; hemodialysis; drug induced hypersensitivity; levetiracetam
• ISSN: 0918-2918; 1349-7235
• DOI: 10.2169/internalmedicine.8985-21

A 59-year-old man undergoing hemodialysis was administered levetiracetam, after which he developed a systemic rash, high fever, severe liver dysfunction, and leukocytopenia with reactivation of human herpes virus 6. Atypical drug-induced hypersensitivity (DIHS) was diagnosed, and prednisolone was administered at 60 mg/day. However, liver failure rapidly progressed, and the patient died 12 days following treatment. Despite the rarity of DIHS with concomitant fulminant liver failure from levetiracetam and sufficient clearance thereof by hemodialysis, our case suggests that this syndrome may still ensue, resulting in mortality, even in hemodialysis patients. Although no treatment has yet been established, strict monitoring and aggressive treatment may be required.