Dose-related levetiracetam-induced reticulated drug eruption

Cutaneous drug eruptions are to antiepileptic drugs (AEDs) used for seizure prophylaxis can range from a maculopapular eruption to severe Stevens-Johnson syndrome or toxic epidermal necrolysis. The aromatic drugs: phenytoin, carbamazepine, oxcarbazepine, phenobarbital, primidone, zonisamide and lamotrigine are the most common offenders. In contrast, the second generation AEDs like valproate, topiramate, gabapentin, tiagabine and levetiracetam are rarely associated with a rash. Doses of AEDs are often started low and gradually increased to decrease the risk of allergic reactions. Herein, the authors report a 46-year-old woman with malignant brain tumor, who developed a levetiracetam induced dose-related reticular eruption only after the initial post-operative dose 500 mg twice a day was increased to 1000 mg twice a day, and upon re-challenge when the slower titrated levetiracetam dose reached 750 mg twice a day.