Thrombocytopenia, pancytopenia, hypogammaglobulinemia and B cell deficiency have been reported in some patients with the administration of anti-epileptic medicines such as carbamazepine, phenytoin and valproate.1C3 LEV is a new generation antiepileptic drug reported to have a high degree of effectiveness and tolerability in epilepsy treatment since 1999.4 In systematic evaluations, it is also considered a safer alternative monotherapy as an antiepileptic drug in pregnancy.5 The most commonly observed HQL-79 adverse effects of the drug are somnolence, agitation, asthenia, headache, abnormal behaviour and depression.4 Hematological disorders such as pancytopenia, thrombocytopenia and platelet dysfunction have been reported. 6C11 Stevens-Johnson syndrome and psychotic disorders have been observed in some instances.12,13 We statement a rare case of B cell aplasia and hypogammaglobulinemia after LEV treatment. CASE A 45-year-old female was operated on for any pituitary tumor with transsphenoidal pituitary surgery. phenytoin and valproate.1C3 LEV is a new generation antiepileptic drug reported to have a high degree of efficacy and tolerability in epilepsy treatment since 1999.4 In systematic evaluations, it is also considered a safer alternative monotherapy as an antiepileptic drug in pregnancy.5 The most commonly observed adverse effects of the drug are somnolence, agitation, asthenia, headache, abnormal behaviour and depression.4 Hematological disorders such as pancytopenia, thrombocytopenia and platelet dysfunction have been reported.6C11 Stevens-Johnson syndrome and psychotic disorders have been observed in some instances.12,13 We statement a rare case of B cell aplasia and hypogammaglobulinemia after LEV treatment. CASE A 45-year-old woman was managed on for any pituitary tumor with transsphenoidal pituitary surgery. A second operation was required to restoration the postoperative rhinorrhea (cerebrospinal fluid, CSF leak). After the operation, the patient was re-evaluated due to complaints of headache, nausea, loss of hunger, and fever. Based on CSF microscopy results, she was hospitalized HQL-79 with the analysis of meningitis. The patient was started on cefotaxime for 4 days and Rabbit polyclonal to FN1 then switched to meropenem) and vancomycin. At 18 days, when no significant improvement was observed in CSF microscopy, the patient was started on ampicillin for agglutination was also bad. Skin tuberculin test was bad. Immunological examination showed decreased levels of IgG (778 mg/dL, normal: 913C1884 mg/dL) and IgA (97 mg/dL, n: 139C378 mg/dL). Her serum level of IgM was normal (108 mg/dL, n: 88C322 mg/dL). Peripheral blood flow cytometric analysis exposed the absence of B cells (CD19+ B cells; 1%) (n: 7C23%) (Number 1). T cell subsets and natural killer cell figures were normal. Neutrophil function, chemotaxis, phagocytosis and oxidative burst activity were normal. Isohemagglutinin titers, levels of pneumococcal and tetanus specific IgG antibodies were also normal. Immunological studies are demonstrated in Table 1. Open in a separate window Number 1 The percentage of CD19+ B lymphocytes; a) at admission b) 20 days after preventing levetiracetam c) 2 weeks after preventing levetiracetam. Table 1 Serum concentrations of immunoglobulins during and after LEV therapy. thead th valign=”middle” align=”remaining” rowspan=”1″ colspan=”1″ /th th colspan=”7″ valign=”middle” align=”center” rowspan=”1″ Serum concentrations (mg/dL) /th th valign=”middle” align=”remaining” rowspan=”1″ colspan=”1″ /th th valign=”middle” align=”center” rowspan=”1″ colspan=”1″ IgG /th th valign=”middle” align=”center” rowspan=”1″ colspan=”1″ IgA /th th valign=”middle” align=”center” rowspan=”1″ colspan=”1″ IgM /th th valign=”middle” align=”center” rowspan=”1″ colspan=”1″ IgG1 /th th valign=”middle” align=”center” rowspan=”1″ colspan=”1″ IgG2 /th th valign=”middle” align=”center” rowspan=”1″ colspan=”1″ IgG3 /th th valign=”middle” align=”center” rowspan=”1″ colspan=”1″ IgG4 /th th colspan=”8″ valign=”middle” align=”remaining” rowspan=”1″ hr / /th /thead 84 days after starting LEV778971085941671719.7100 HQL-79 days after starting LEV876107136NTNTNTNT19 days after stopping LEV81699.6140744117291863 days after stopping LEV119099.6135NTNTNTNT181 days after stopping LEV1630182543NTNTNTNT404 days after stopping LEV114022618110301832719Normal ranges913C1884139C37888C322643C1071179C43517C8314C80 Open HQL-79 in a separate window NT: not tested, LEV: levetiracetam The Naranjo adverse drug reaction probability score14 was 6 (+2 for occurrence of B cell aplasia and hypogammaglobulinemia after administration of LEV, +1 for improvement of B cell aplasia and hypogammaglobulinemia following discontinuation of LEV, +2 for the absence of an alternative causes for the adverse event, +1 for the confirmation by objective evidence). The antiepileptic drug was discontinued after epileptic seizures were controlled. B cells gradually improved three weeks later on (CD19+ B cells: 4%, CD20: 4.1%, CD21:2.8%, CD22: 5.8%) and returned to normal within two months (CD19+ B cells: 9.8%) (Number 1). In the one 12 months follow-up period, the number of B cells was stable and the patient was doing well without any illness. Conversation Levetiracetam (LEV) is definitely a well-tolerated and efficacious anticonvulsant drug against a broad range of seizure types.15,16 To our knowledge, this is the first report of B cell aplasia due to the use of LEV. In the literature, B cell aplasia has been described with the use of antiepileptic medicines as carbamazepine in a few instances.1,17,18 Yamamoto et al1 reported a case of hypogammaglobulinemia associated with aplasia of B lymphocytes after carbamazepine treatment inside a 33-year-old man who suffered.