A Rare Cause of Hypertransaminasemia in a Child with Epilepsy Taking Levetiracetam: Salmonella Hepatitis

Abstract

Salmonella hepatitis is an infectious disease caused by liver involvement of salmonella enteritis and characterized by acute gastroenteritis and hypertransaminasemia. Levetiracetam is a new generation antiepileptic agent that activates the GABA-glycine system and may rarely cause hypertransaminasemia. An 11-year-old girl with epilepsy who had been taking levetiracetam for 15 months was consulted because of hypertransaminasemia with nausea-vomiting, fever and abdominal pain. The patient was diagnosed with salmonella enteritis. The clinical findings regressed with appropriate antibiotherapy but hypertransaminasemia lasted. The etiology of persistent hypertransaminasemia has been investigated. In addition to salmonella hepatitis, the use of levetiracetam was seen as causes but the drug was not discontinued. Normal liver enzyme levels were reached in the 12th weeks following Salmonella infection. Consequently, it is considered that before discontinuation of medication, salmonella hepatitis may be in differential diagnosis in patients who have acute gastroenteritis and hepatitis findings and also receiving levetiracetam.

Keywords

• Hypertransaminasemia
• Levetiracetam
• Salmonella

Levetirasetam Kullanan Epilepsili Bir Çocuk Hastada Hipertransaminaseminin Nadir Bir Nedeni: Salmonella Hepatiti

Abstract

Salmonella hepatiti, salmonella enteritinin karaciğeri tutmasıyla oluşan bir enfeksiyon hastalığı olup akut gastroenterit bulguları ve hipertransaminazemi ile seyreder. Levetirasetam, GABA-glisin sistemini aktive ederek antiepileptik etki gösteren yeni nesil bir antiepileptik ajandır ve nadiren hipertransaminazemiye yol açabilmektedir. Epilepsi tanısıyla 15 aydır levetirasetam kullanmakta olan 11 yaşında bir kız hasta, bulantı-kusma, ateş, karın ağrısı şikayetleriyle birlikte hipertransaminazemi olması nedeniyle başvurdu. Salmonella hepatiti tanısı konulan hastada uygun antibiyoterapi ile klinik bulgular gerilemesine rağmen hipertransaminazeminin 12 hafta sürdüğü gözlendi. Persistan hipertransaminazemi etiyolojisi araştırıldı. Sonuç olarak, levetirasetam kullanan, akut gastroenterit ve hepatit bulgularıyla getirilen hastalarda ilaç tedavisi kesilmeden önce salmonella hepatitinin de ayırıcı tanıda düşünülmesi gerektiği değerlendirilmektedir.

Keywords

• levetirasetam
• Salmonella
• Hipertransaminazemi

References

1. 1. Bhatti, J. M., Memon, Y., Sarfaraz, S. & Salahuddin, N. An Unusual Case of Extensively Drug Resistant Typhoid Fever. Cureus11, (2019).
2. 2. El-Newihi, H. M., Alamy, M. E. & Reynolds, T. B. Salmonella hepatitis: Analysis of 27 cases and comparison with acute viral hepatitis. Hepatology24, 516–519 (199 PH:7,29 PCO2:60,8 HCO3:28,9 LAC:0,9 6).
3. 3. Pramoolsinsap, C. & Viranuvatti, V. Salmonella hepatitis. J. Gastroenterol. Hepatol.13, 745–750 (1998).
4. 4. Khosla, S. N. Typhoid hepatitis. Postgrad. Med. J.66, 923–925 (1990).
5. 5. Vatansev, C., Gölcük, M., Hüseyin, Y. & Pamukçu, A. Salmonella hepatiti : Tıkanma sarılığı ile karışan iki olgu. 13, 131–134 (2003).
6. 6. Verrotti, A. et al. The adverse event profile of levetiracetam: A meta-analysis on children and adults. Seizure31, 49–55 (2015).
7. 7. Algahtani, H., Marghalani, S., Satti, M. & Shirah, B. Levetiracetam-Induced Skin Hyperpigmentation: An Extremely Rare Undesirable Side Effect. J. Epilepsy Res.7, 106–108 (2017).
8. 8. Alzahrani, T. et al. Levetiracetam-induced pancytopenia. Epilepsy Behav. Case Reports4, 45–47 (2015)

9. 9. Rastogi, V., Singh, D., Kaur, B., Arora, P. & Gadikota, J. P. Rhabdomyolysis: A Rare Adverse Effect of Levetiracetam. Cureus10, 8–11 (2018)
10. 10. Bölükbaşi, N., Akar, F., & Bır, S. (2011). Antiepileptik İlaçların Lipit Profili ve Karaciğer Enzimleri Üzerine Etkisi. Archives of Neuropsychiatry/NoropsikiatriArsivi, 48(1).
11. 11. Sethi, N. K., Sethi, P. K., Torgovnick, J., Arsura, E. & Cukierwar, F. Asymptomatic elevation of liver enzymes due to levetiracetam: A case report. Drug Metabol. Drug Interact.28, 123–124 (2013).
12. 12. Rachamallu, V., Song, M. M., Reed, J. M. & Aligeti, M. Levetiracetam-induced transaminitis in a young male with traumatic brain injury. Oxford Med. Case Reports2017, 212–214 (2017).