Drug-induced Liver Injury Caused by Levetiracetam

Levetiracetam, known as Keppra, is an antiepileptic drug that is commonly used due to its rare side effects, particularly on the liver. It is mainly excreted by the kidneys with minimal hepatic metabolism. Drug-induced liver injury associated with Levetiracetam is extremely rare. Few cases of Levetiracetam-induced liver toxicity and failure were declared. Until now, there are no previously reported cases of mixed pattern liver injury related to this drug. We report a case of a patient taking Levetiracetam, that was found to have mixed pattern liver injury. Our patient experienced important rapid improvement of hepatocellular injury and a delayed improvement of cholestatic pattern after Levetiracetam discontinuation, suggesting the mentioned association. This case report is the first to establish both hepatocellular and cholestatic injury associated with Levetiracetam. We would like to highlight this side effect, though rare, of this frequently used drug in medical practice.