|CASE BASED LEARNING
|Year : 2015 | Volume
| Issue : 1 | Page : 53-55
A Case of phenytoin drug hypersensitivity syndrome
Sushil Pande, Shuken Dashore
Department of Dermatology, NKP Salve Institute of Medical Sciences and Lata Mangeshkar Hospital, Nagpur, Maharashtra, India
|Date of Web Publication||1-Dec-2015|
Department of Dermatology, NKP Salve Institute of Medical Sciences and Lata Mangeshkar Hospital, Hingna, Nagpur, Maharashtra - 440 019
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Pande S, Dashore S. A Case of phenytoin drug hypersensitivity syndrome. Indian J Drugs Dermatol 2015;1:53-5
| Case Report|| |
A 16-year-old male patient came with complains of high-grade fever for 8 days and rash over body of 7 days duration. Fever was high-grade, continuous, not associated with chills, and decreased on medication. Rash was itchy and was associated with swelling and painful ulceration of the lips. The patient was a known case of seizure disorder and was started on phenytoin 300 mg twice daily, 30 days back.
On examination, the patient was febrile (temperature-102°F) with pulse of 94 beats/min and had hypotension (blood pressure -90/70 mm of Hg). The patient had facial edema and bilateral pedal edema of pitting type and multiple enlarged discrete nontender lymph nodes in the cervical, axillary, and inguinal regions. The patient also had tender hepatomegaly 2 cm below the costal margin, and liver enzymes were elevated more than twice over the baseline. Skin examination showed multiple erythematous papules with blanchable confluent erythema present over trunk [Figure 1], arm, back, face, and legs. Mild scaling was seen over palms and soles. Oral examination showed multiple shallow ulcers over lips and buccal mucosa with hemorrhagic and purulent crusting [Figure 2].
|Figure 2: Hemorrhagic crusting of lips in drug hypersensitivity syndrome.|
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Based on the clinical features and investigations, the patient was diagnosed to be a case of drug hypersensitivity syndrome (DHS) due to phenytoin. Phenytoin was stopped immediately and the patient was put on alternative anti-epileptic drug. He was started on systemic corticosteroids following which the patient had improved dramatically.
| Questions|| |
- Why the diagnosis of phenytoin-induced DHS was made in this case?
- What are the criteria for the diagnosis of DHS?
- How you will differentiate in this case between drug-induced fever vis-à-vis fever of infective origin?
- How will you assess systemic involvement in this patient and why it is important to do so?
- As this patient requires anti-epileptic for seizure disorder, what drug substitution should be done?
- Is there any predictive test for predicting phenytoin toxicity?
| References|| |
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Kim DH, Koh YI. Comparison of diagnostic criteria and determination of prognostic factors for drug reaction with eosinophilia and systemic symptoms syndrome. Allergy Asthma Immunol Res 2014;6:216-21.
Kumari R, Timshina DK, Thappa DM. Drug hypersensitivity syndrome. Indian J Dermatol Venereol Leprol 2011;77:7-15.
Vittorio CC, Muglia JJ. Anticonvulsant hypersensitivity syndrome. Arch Intern Med 1995;155:2285-90.
Saito Y, Kodama S, Sugiyama E, Nakamura R. Predictive genomic markers for severe adverse drug reactions. Yakugaku Zasshi 2015;135:589-95.
[Figure 1], [Figure 2]