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
References
- 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.
- Rastogi V. Rhabdomyolysis: A Rare Adverse Effect of Levetiracetam. Cureus 2018;10:e2705.
- 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.
- Shapiro ML, Baldea A, Luchette FA. Rhabdomyolysis in the intensive care unit. J Intensive Care Med 2012;27:335-42.
- Di Lorenzo R, Li Y. Rhabdomyolysis associated with levetiracetam administration. Muscle Nerve 2017; 56: E1–2.
- Singh R, Patel DR, Pejka S. Rhabdomyolysis in a hospitalized 16-year-old boy: A rarely reported underlying cause. Case Rep Pediatr 2016; 7873813.
- 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.
- 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.
- Incecik F, Herguner OM, Besen S, Altunbasak S. Acute rhabdomyolysis associated with levetiracetam therapy in a child. Acta Neurol Belg 2016 ;116:369-70.
- Rota E, Arena L, Celli L, Testa L, Morelli N. Levetiracetam-induced rhabdomyolysis: the first Italian case. Neurol Sci 2018;39:1629-30.
- Moinuddin IA. Suspected Levetiracetam-Induced Rhabdomyolysis: A Case Report and Literature Review. Am J Case Rep 2020;21:e926064.
- Szugye HS. Pediatric Rhabdomyolysis. Pediatr Rev 2020;41:265-75.
- Jakimiec M, Paprocka J, Śmigiel R. CDKL5 Deficiency Disorder—A Complex Epileptic Encephalopathy. Brain Sci 2020;10:107.
- 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.
- 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.
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
References
- 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.
- Rastogi V. Rhabdomyolysis: A Rare Adverse Effect of Levetiracetam. Cureus 2018;10:e2705.
- 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.
- Shapiro ML, Baldea A, Luchette FA. Rhabdomyolysis in the intensive care unit. J Intensive Care Med 2012;27:335-42.
- Di Lorenzo R, Li Y. Rhabdomyolysis associated with levetiracetam administration. Muscle Nerve 2017; 56: E1–2.
- Singh R, Patel DR, Pejka S. Rhabdomyolysis in a hospitalized 16-year-old boy: A rarely reported underlying cause. Case Rep Pediatr 2016; 7873813.
- 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.
- 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.
- Incecik F, Herguner OM, Besen S, Altunbasak S. Acute rhabdomyolysis associated with levetiracetam therapy in a child. Acta Neurol Belg 2016 ;116:369-70.
- Rota E, Arena L, Celli L, Testa L, Morelli N. Levetiracetam-induced rhabdomyolysis: the first Italian case. Neurol Sci 2018;39:1629-30.
- Moinuddin IA. Suspected Levetiracetam-Induced Rhabdomyolysis: A Case Report and Literature Review. Am J Case Rep 2020;21:e926064.
- Szugye HS. Pediatric Rhabdomyolysis. Pediatr Rev 2020;41:265-75.
- Jakimiec M, Paprocka J, Śmigiel R. CDKL5 Deficiency Disorder—A Complex Epileptic Encephalopathy. Brain Sci 2020;10:107.
- 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.
- 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.
Details
| Primary Language | English |
|---|---|
| Subjects | Internal Diseases |
| Journal Section | CASE REPORTS |
| Authors | |
| Early Pub Date | May 3, 2023 |
| Publication Date | July 25, 2023 |
| Submission Date | November 24, 2021 |
| Published in Issue | Year 2023 Volume: 17 Issue: 4 |
The publication language of Turkish Journal of Pediatric Disease is English.
Manuscripts submitted to the Turkish Journal of Pediatric Disease will go through a double-blind peer-review process. Each submission will be reviewed by at least two external, independent peer reviewers who are experts in the field, in order to ensure an unbiased evaluation process. The editorial board will invite an external and independent editor to manage the evaluation processes of manuscripts submitted by editors or by the editorial board members of the journal. The Editor in Chief is the final authority in the decision-making process for all submissions. Articles accepted for publication in the Turkish Journal of Pediatrics are put in the order of publication, with at least 10 original articles in each issue, taking into account the acceptance dates. If the articles sent to the reviewers for evaluation are assessed as a senior for publication by the reviewers, the section editor and the editor considering all aspects (originality, high scientific quality and citation potential), it receives publication priority in addition to the articles assigned for the next issue.
The aim of the Turkish Journal of Pediatrics is to publish high-quality original research articles that will contribute to the international literature in the field of general pediatric health and diseases and its sub-branches. It also publishes editorial opinions, letters to the editor, reviews, case reports, book reviews, comments on previously published articles, meeting and conference proceedings, announcements, and biography. In addition to the field of child health and diseases, the journal also includes articles prepared in fields such as surgery, dentistry, public health, nutrition and dietetics, social services, human genetics, basic sciences, psychology, psychiatry, educational sciences, sociology and nursing, provided that they are related to this field. can be published.