Suspected levetiracetam drug-induced lupus in a child: A case report

Drug-induced lupus erythematosus (DIL) is an uncommon condition that mimics systemic lupus erythematosus (SLE) and accounts for approximately 10%-12% of SLE cases. Numerous drugs have been implicated, most commonly hydralazine, procainamide, isoniazid, and certain antiepileptics. Levetiracetam has rarely been associated with SLE. We describe the first known possible pediatric case of suspected levetiracetam-induced lupus erythematosus. A previously healthy 6-year-old girl developed thrombocytopenia, neutropenia, anemia, generalized lymphadenopathy, and a petechial rash several months after initiating levetiracetam therapy for absence seizures. Extensive infectious and oncologic investigations, including a bone marrow biopsy and an excisional lymph node biopsy were unremarkable. Given the temporal association with levetiracetam exposure, the presence of clinical features consistent with DIL, and a serological pattern suggestive of DIL, the drug was discontinued, and the patient was treated with corticosteroids, intravenous immunoglobulin, and hydroxychloroquine. She demonstrated rapid clinical and biochemical improvement. Although distinguishing DIL from early SLE remains challenging and no definitive diagnostic criteria exist, this case met several proposed features of DIL and scored as a possible adverse drug reaction on the Naranjo scale. This report expands the spectrum of levetiracetam-associated adverse effects and highlights the need for clinicians to consider DIL in pediatric patients even when receiving drugs with generally favorable safety profiles.