İki Yaşındaki Kız Çocuğunda Levetirasetama Bağlı Akut Rabdomiyoliz

Abstract

Levetirasetam çocukluk çağında fokal ve jeneralize nöbetlerin tedavisi için kullanılan en güvenilir antiepileptik ilaçlardan birisidir. Şimdiye kadar levetirasetama bağlı akut rabdomiyoliz tanılı az sayıda hasta bildirilmiştir ve vakamız literatürde bildirilmiş en genç vakadır. Atipik Rett sendromu (CDKL5 eksikliği) tanısıyla izlenen iki yaşındaki kız hasta pnömoni ve solunum yetmezliği nedeniyle hastanemize kabul edildi. İntravenöz antibiyotik ve levetirasetam tedavisi alıyordu. Klinik izleminde kreatin kinaz düzeylerinde yükselme devam etti, intravenöz hidrasyon ve alkalinizasyon tedavisine eklendi. Kreatin kinaz düzeylerinde yükselmeyi açıklayacak neden bulamadığımız için hastamızda rabdomiyolizin levetirasetama bağlı olabileceği düşünüldü ve levetirasetam tedavisi kesildi. Levetirasetam kesildikten sonra 24 saat içerisinde kreatin kinaz düzeyi düşmeye başladı ve bir hafta içersinde normal düzeylerine döndü. Levetirasetama bağlı rabdomiyoliz çok nadir fakat hayatı tehdit eden bir durum olup özellikle çocukluk çağındaki hastalarda akılda tutulmalıdır. Levetirasetam tedavisinin ilk haftasındaki tüm hastaların kreatin kinaz düzeyleri ve böbrek fonksiyon testleri izlenmelidir. Erken tanı ve tedavi akut böbrek hasarını önlemek açısından çok önemlidir. CDKL5 eksikliği hastamızda akut böbrek hasarını önleyecek koruyucu faktör olabilir ancak bu konuyla ilgili daha fazla sayıda araştırmaya ihtiyaç vardır.

Keywords

• Levetiracetam
• rhabdomyolysis
• child

Acute rhabdomyolysis due to levetiracetam in a two-year-old girl

Abstract

Levetiracetam is one of the safest drugs which is used for the treatment of focal and generalized seizures during childhood. Until now, few patients have been reported with the diagnosis of acute rhabdomyolysis due to levetiracetam and our case is the youngest patient in the literature. Two-year old girl followed with atypical Rett syndrome (CDKL 5 deficiency) was admitted to our hospital with pneumonia and respiratory insufficiency. She was receiving intravenous antibiotics and levetiracetam therapy. During follow-up, the increase of creatine kinase levels continued, intravenous hydration and alkalinization was added on therapy. As we could not find any etiology explaining the raising creatine kinase levels in our patient, levetiracetam was thought to be the cause of rhabdomyolysis and withdrawn. After discontinuation of levetiracetam, creatine kinase levels began to decline within 24 h and returned to normal levels in one week. Levetiracetam-induced rhabdomyolysis is quite rare but is a life-threatening condition and should be kept in mind especially during childhood. The creatine kinase levels and renal function tests of all patients should be followed in the first week of levetiracetam therapy. Early diagnosis and supportive therapy is very important in order to prevent acute kidney injury. CDKL 5 deficiency can be a protective factor which might prevent acute kidney injury in our patient but more research is needed about this topic. 

Keywords

• Child
• Levetiracetam
• rhabdomyolysis

References

1. Akiyama H, Haga Y, Sasaki N, Yanagisawa T, Hasegawa Y. A case of rhabdomyolysis in which levetiracetam was suspected as the cause. Epilepsy Behav Case Rep 2014; 2: 152–5.
2. Rastogi V. Rhabdomyolysis: A Rare Adverse Effect of Levetiracetam. Cureus 2018;10:e2705.
3. Hamel Y, Mamoune A, Mauvais FX, Habarou F, Lallement L, Romero NB, et al. Acute rhabdomyolysis and inflammation. J Inherit Metab Dis 2015;38:621-8.
4. Shapiro ML, Baldea A, Luchette FA. Rhabdomyolysis in the intensive care unit. J Intensive Care Med 2012;27:335-42.
5. Di Lorenzo R, Li Y. Rhabdomyolysis associated with levetiracetam administration. Muscle Nerve 2017; 56: E1–2.
6. Singh R, Patel DR, Pejka S. Rhabdomyolysis in a hospitalized 16-year-old boy: A rarely reported underlying cause. Case Rep Pediatr 2016; 7873813.
7. Kubota K, Yamamoto T, Kawamoto M, Kawamoto N and Fukao T. Levetiracetam-induced rhabdomyolysis: A case report and literature review. Neurol Asia 2017;22: 275–8.
8. Aslan N, Yildizdas D, Huseyınlı B, Horoz OO, Mert GG, Ekinci F, et al. Levetiracetam Treatment-Associated Acute Rhabdomyolysis in an Adolescent. J Pediatr Intensive Care 2020;9:139–40.

9. Incecik F, Herguner OM, Besen S, Altunbasak S. Acute rhabdomyolysis associated with levetiracetam therapy in a child. Acta Neurol Belg 2016 ;116:369-70.
10. Rota E, Arena L, Celli L, Testa L, Morelli N. Levetiracetam-induced rhabdomyolysis: the first Italian case. Neurol Sci 2018;39:1629-30.
11. Moinuddin IA. Suspected Levetiracetam-Induced Rhabdomyolysis: A Case Report and Literature Review. Am J Case Rep 2020;21:e926064.
12. Szugye HS. Pediatric Rhabdomyolysis. Pediatr Rev 2020;41:265-75.
13. Jakimiec M, Paprocka J, Śmigiel R. CDKL5 Deficiency Disorder—A Complex Epileptic Encephalopathy. Brain Sci 2020;10:107.
14. Kim JY, Bai Y, Jayne LA, Cianciolo RE, Bajwa A, Pabla NS. Involvement of the CDKL5-SOX9 signaling axis in rhabdomyolysis-associated acute kidney injury. Am J Physiol Renal Physiol 2020;319:F920-9.
15. Indika NLR, Vidanapathirana DM, Jasinge E, Waduge R, Shyamali NLA, Perera PPR. Lipin-1 Deficiency-Associated Recurrent Rhabdomyolysis and Exercise-Induced Myalgia Persisting into Adulthood: A Case Report and Review of Literature. Case Rep Med 2020;27:7904190.