Levetiracetam‐Induced Acute Generalized Exanthematous Pustulosis

Antiepileptic drugs have been associated with many adverse effects, including different types of rashes; however, the frequency of rash varies among the drugs. The most common adverse effects associated with levetiracetam include somnolence, asthenia, headache, dizziness, and behavioral abnormalities. Until recently, rash had not been reported as an adverse effect of levetiracetam in adults. We describe a 45-year-old, African-American woman who developed a desquamating rash after starting levetiracetam for a witnessed seizure. The rash improved after the drug was discontinued, but on rechallenge, the desquamating rash reappeared. The patient was hospitalized, levetiracetam was discontinued, and supportive care and treatment with triamcinolone 0.1% cream and oral prednisone were started. Her rash was biopsied, and she was diagnosed with drug-induced acute generalized exanthematous pustulosis (AGEP). With topical and oral steroid treatment the patient's rash improved, and she was discharged on hospital day 4. Use of the Naranjo adverse drug reaction probability scale indicated a probable relationship (score of 6) between the patient's development of AGEP and levetiracetam exposure. To our knowledge, this is the first case report of levetiracetam-induced AGEP. Although levetiracetam is usually well tolerated, clinicians should be aware of this potential adverse drug reaction in patients who develop severe skin reactions while receiving this drug.