SHM Converge Scientific Abstract ePoster Gallery-Following the Ck: A Rare Case of Levetiracetam-Induced Rhabdomyolysis

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This case describes a 41-year-old woman with factor V Leiden who presented after a witnessed seizure while driving. She was hemodynamically stable and had no trauma or other major exam findings. Initial labs showed a mildly elevated creatine phosphokinase (CPK) of 671, and she was treated with IV fluids and loaded with levetiracetam (Keppra), then maintained on 500 mg twice daily.<br /><br />Despite hydration and preserved urine output, her CPK levels continued to rise after an initial decline, reaching a peak of 18,616 by hospital day 3. Because the CK elevation worsened without another clear explanation, levetiracetam was suspected as the cause of rhabdomyolysis and was discontinued. Within 12 hours, her CPK began to downtrend, supporting the diagnosis of levetiracetam-induced rhabdomyolysis.<br /><br />The report emphasizes that although seizures themselves can cause muscle injury and elevated CK, persistent or worsening CK despite appropriate fluid resuscitation should prompt evaluation for rarer causes. Levetiracetam is widely used for seizure management and is generally well tolerated, but rhabdomyolysis is a rare and potentially serious adverse effect. Reported cases typically occur within 12–36 hours of starting the drug, with CK peaking 3–5 days later. Interestingly, this patient did not develop classic rhabdomyolysis symptoms such as muscle pain or dark urine, making the diagnosis more difficult.<br /><br />The authors conclude that clinicians should maintain a high index of suspicion for levetiracetam-induced rhabdomyolysis, especially when CK fails to improve as expected. Early recognition and prompt drug discontinuation may prevent kidney injury, prolonged hospitalization, and unnecessary fluid overload.

Asset Subtitle

Roma Patel

Meta Tag

Author List Hardik Fichadiya, Hesham Elmariah, Midhun Mathew, Roma Patel

Category Clinical Vignettes

Concept Levetiracetam

Concept Medication-Induced Rhabdomyolysis

Concept Creatine Kinase

Concept Adverse Drug Reaction

Distinguished Non-Finalist

Presenter Organization Trinitas Regional Medical Center

Presenting Author Roma Patel

Track Adult

Keywords

levetiracetam

rhabdomyolysis

creatine phosphokinase

seizure

factor V Leiden

CK elevation

drug-induced myopathy

hospitalization

IV fluids

adverse effect

Levetiracetam

Medication-Induced Rhabdomyolysis

Creatine Kinase

Adverse Drug Reaction