İki Yaşındaki Kız Çocuğunda Levetirasetama Bağlı Akut Rabdomiyoliz

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.

Anahtar Kelimeler:

Levetiracetam, rhabdomyolysis, child

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

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the raising creatine kinase levels in our patient, levetiracetam was thought to be the cause of rhabdomyolysis and withdrawn.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,

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