The question of whether the anti-seizure medication Keppra (levetiracetam) can cause swollen lymph nodes is critically important for patient safety. The direct answer is yes, though this is not a common side effect. Swollen lymph nodes, or lymphadenopathy, can occur as part of a severe, and potentially fatal, allergic reaction known as Drug Reaction with Eosinophilia and Systemic Symptoms, or DRESS syndrome. Due to the serious nature of this condition, the U.S. Food and Drug Administration (FDA) issued a safety communication in 2023 requiring manufacturers to add new warnings to the prescribing information and patient medication guides for levetiracetam.
Understanding the DRESS Syndrome Connection
DRESS is a delayed-onset, severe hypersensitivity reaction that can affect multiple organ systems. It is a medical emergency that can lead to hospitalization, permanent organ damage, and in some cases, death. The latency period between starting the medication and the onset of DRESS is typically two to eight weeks, but symptoms can appear earlier or later. This delay can sometimes make it difficult to immediately link the symptoms to the medication, which is why heightened awareness is so crucial.
Key Symptoms of DRESS Syndrome
Recognizing the cluster of symptoms associated with DRESS is vital for prompt diagnosis and treatment. The key signs often begin with a non-specific viral-like illness before progressing to more serious manifestations.
- Skin Rash: This can vary but often presents as a widespread rash of flat-to-slightly-raised red spots, which may later blister or peel. In some cases, a rash may not be present in the early stages, though other symptoms like fever and swollen lymph nodes may be.
- Fever: A persistent, unexplained fever is a very common early symptom.
- Swollen Lymph Nodes: Lymphadenopathy, or swollen glands, are a key indicator of the body's systemic inflammatory response. These can be felt in the neck, underarms, or groin.
- Organ Injury: As the condition progresses, DRESS can cause injury to internal organs. This may include the liver (hepatitis), kidneys (renal failure), lungs, heart, or pancreas. Signs of organ involvement can include yellowing of the skin or eyes (jaundice) or unusual bruising.
- Eosinophilia: A high count of eosinophils, a type of white blood cell, is a hallmark of DRESS and is often found in blood tests.
The FDA Warning on Levetiracetam
In November 2023, the FDA announced it was requiring new warnings for levetiracetam (Keppra) and another anti-seizure medication, clobazam. This decision was based on a review of global and U.S. reports of serious DRESS cases in both children and adults. According to data submitted to the FDA and medical literature, 32 cases of DRESS were reported in patients taking levetiracetam. Most patients required hospitalization, and tragically, two fatalities were reported. The FDA's action emphasizes the need for immediate medical attention if symptoms such as a rash, fever, or swollen lymph nodes develop, regardless of when they occur during treatment.
Recognizing the Symptoms: When to Seek Help
While swollen lymph nodes can have many benign causes, such as a cold or infection, their appearance alongside other symptoms while taking Keppra is a red flag. If you or someone you are caring for develops any of the following symptoms, seek emergency medical care immediately:
- An unexplained rash, especially one that spreads or becomes blistering.
- A persistent or new fever.
- Swollen lymph nodes in the neck, underarms, or groin.
- Swelling of the face, lips, or tongue.
- Sore throat or mouth sores.
- Flu-like symptoms, body aches, or a general feeling of being unwell.
- Yellowing of the skin or eyes (jaundice).
Comparison Table: DRESS vs. Common Viral Infection
Understanding the differences between a typical infection and DRESS syndrome can aid in recognition, but should not replace professional medical judgment.
| Feature | DRESS Syndrome (Possible Keppra-Related) | Common Viral Infection (e.g., Cold/Flu) |
|---|---|---|
| Onset | Delayed (often 2-8 weeks after starting Keppra) | Immediate (typically within days of exposure) |
| Rash | Widespread, often with red spots; can blister or peel; may not appear initially | Mild, less common, or absent; usually disappears with recovery |
| Fever | High, persistent, and unexplained | Typically subsides as infection clears |
| Swollen Lymph Nodes | Systemic, prominent, and often accompanied by other severe symptoms | Localized (e.g., neck with a sore throat); resolves with infection |
| Organ Involvement | Common, potentially leading to liver, kidney, or other organ damage | Rare; localized effects common (e.g., sinus congestion) |
| Severity | Life-threatening; requires emergency medical attention | Mild to moderate; typically self-resolving |
Other Potential Causes of Swollen Lymph Nodes
It is important to remember that most cases of swollen lymph nodes are not related to medication side effects. Common reasons for swollen lymph nodes include:
- Infections: Viral infections like the common cold or flu, mononucleosis, bacterial infections, or strep throat.
- Inflammatory Conditions: Certain autoimmune diseases.
- Injury: Trauma or infection near a lymph node.
Because the symptoms of DRESS can mimic a more common infection, it is the combination of signs, especially the delayed onset, that should raise suspicion. Only a healthcare professional can accurately diagnose the cause.
Management and Medical Evaluation
If DRESS is suspected, doctors will perform a physical examination and may order blood tests to check for eosinophilia and signs of organ damage, particularly liver and kidney function. It is important not to stop Keppra abruptly without medical supervision, as this can lead to uncontrolled seizures. The healthcare provider will guide the treatment plan, which may involve discontinuing Keppra and managing the allergic reaction in a hospital setting. After an episode of DRESS, patients are typically advised to avoid the triggering medication permanently. More information can be found at the Epilepsy Foundation or other reputable medical sources.
Conclusion
While relatively rare, the potential for Keppra to cause swollen lymph nodes as a symptom of DRESS syndrome is a significant and serious risk that patients and caregivers must be aware of. The 2023 FDA warning underscores the importance of vigilance, particularly regarding unexplained rashes, fevers, and swelling, especially several weeks after beginning the medication. Immediate medical attention is essential for a prompt diagnosis and treatment, which can be life-saving. Open communication with your healthcare team is paramount for managing your treatment safely and effectively.
