Levetiracetam-induced leukocytoclastic vasculitis

Abstract

Drug-induced leukocytoclastic vasculitis is a small-vessel vasculitis that most commonly manifests with palpable purpuric lesions on gravity-dependent areas. Vasculitis occurs within weeks after initial administration of medication and demonstrates clearance upon withdrawal of medication. Levetiracetam, a pyrrolidone derivative, is used as an adjunctive therapy in patients with refractory focal epilepsy, myoclonic epilepsy, and primary generalized tonic-clonic seizures. We present a case of a 14-year-old female, who developed cutaneous small-vessel vasculitis within 8 days of initiation of levetiracetam. Vasculitis was successfully managed by discontinuation of medication and systemic corticosteroids. This adverse reaction, to the best of our knowledge, has not been previously reported in literature.

Keywords: Cutaneous small-vessel vasculitis; drug-induced leukocytoclastic vasculitis; immune complex; levetiracetam.

Figure 1

Palpable purpura and necrotic ulcers over lower extremities

Figure 2

Histopathological examination showing red blood cell extravasation, infiltration of neutrophils and eosinophils and fibrinoid necrosis (H and E, ×40) in the dermis