Dilantin Hypersensitivity Syndrome Imitating Staphylococcal Toxic Shock

Potter, Thomas S.; DiGregorio, Fiorino M.; Stiff, Mark A.; Hashimoto, Ken

doi:10.1001/archderm.1994.01690070050007

Cited by 16 publications

(8 citation statements)

References 9 publications

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“…Phenytoin hypersensitivity syndrome is more common in blacks4 5 and typically has its onset 3 weeks to 3 months after initiation of therapy. Although variable in presentation, its hallmark clinical features are fever, a rash (erythroderma, progressing via a generalised maculopapular to a pustular rash and finally desquamation), lymphadenopathy and hepatosplenomegaly 3-6.…”

Section: Discussionmentioning

confidence: 99%

“…Peripheral leucocytosis and eosinophilia are common. Potentially fatal complications associated with the syndrome include hypersensitivity myocarditis,2drug-induced hepatitis with or without hepatocyte necrosis (which carries a mortality of up to 50%),2 7 and compromise of renal and pulmonary functions 4…”

Section: Discussionmentioning

confidence: 99%

“…The underlying mechanisms of the phenytoin hypersensitivity syndrome are unknown9; immune complex,10 and delayed-type hypersensitivity allergic reactions,7alteration of lymphocyte function and toxic metabolite production4 8 have been postulated. Genetic factors are also thought to contribute, since siblings are said to have a one in four risk of showing a similar reaction 5…”

Section: Discussionmentioning

confidence: 99%

“…Genetic factors are also thought to contribute, since siblings are said to have a one in four risk of showing a similar reaction 58 9Cross-reactivity with other aromatic ring anticonvulsants (eg, phenobarbital and carbamazepine) has been reported in patients with a history of phenytoin hypersensitivity 45 8 9 …”

Section: Discussionmentioning

confidence: 99%

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Fatal phenytoin hypersensitivity syndrome

Mahadeva

Al-Mrayat

Steer

et al. 1999

Postgraduate Medical Journal

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SummaryThe clinical features of viral encephalitis consist of headache, fever, seizures and encephalopathy. We report three patients with high-grade gliomas presenting with encephalitic illnesses. The diagnosis of brain tumour should always be borne in mind if definite evidence for a viral infection is not obtained.Keywords: glioma; viral encephalitis; encephalopathy Viral encephalitis is characterised by headache, confusion, altered consciousness with or without seizures, and fever. The most commonly identified cause of sporadic communityacquired encephalitis is herpes simplex virus (HSV) type I, which may be diagnosed on viral culture of cerebrospinal fluid (CSF), polymerase chain reaction (PCR) analysis looking for HSV DNA, serological testing for IgM antibodies, or brain biopsy. Characteristically the virus attacks the medial temporal lobes and insular cortex giving rise to a focal encephalitis which carries a significant mortality rate. 1 Rarely, the patient presents with symptoms and signs of raised intracranial pressure, giving rise to the possibility of a temporal lobe abscess. The converse situation, whereby a high-grade tumour presents as an acute encephalitic illness, has only rarely been reported. The following three cases illustrate that this diagnosis should always be borne in mind if definite evidence for a viral infection causing the encephalopathy is not obtained, especially if the PCR test is negative for the presence of viral DNA. Case reportsCase 1 A 41-year-old woman presented with tonicclonic seizures, fever, drowsiness and confusion. Magnetic resonance imaging (MRI) showed extensive high signal abnormality in the left temporal lobe and posterior parietal region (figure 1). CSF was normal. A presumptive diagnosis of herpes simplex encephalitis (HSE) was made and she improved after intravenous acyclovir. However, her seizures persisted and 2 years later her MRI scan showed an increase in the size of the temporal lesion (figure 1). Approximately one month later, she was found unconscious at home. A CT scan now showed a large lesion with considerable midline shift. Emergency decompression was unsuccessful and she died without regaining consciousness. The histology of the lesion was glioblastoma multiforme. Case 2A 49-year-old man became acutely confused and then had serial tonic-clonic seizures. On admission he was pyrexial, tachycardic and unconscious. MRI showed extensive high T2 signal change aVecting the right temporal and frontal lobes with some mass eVect (figure 2). CSF examination including PCR for HSV DNA was negative. He was started on acyclovir and gradually improved. He had persistent simple partial seizures and a repeat MRI 3 weeks later showed no change. A stereotactic brain biopsy was carried out and revealed an anaplastic astrocytoma. He was treated with external beam radiotherapy followed by combination chemotherapy. Case 3A 72-year-old woman presented with a 2-week history of episodes of vagueness and confusion. MRI revealed a lesion involving the grey and white matter of the...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Fatal phenytoin hypersensitivity syndrome

Mahadeva

Al-Mrayat

Steer

et al. 1999

Postgraduate Medical Journal

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“…This eruption can manifest almost any type of rash from a bland macularpapular exanthem to toxic epidermal necrolysis. This eruption can manifest as erythroderma [62] or can mimic the exanthem of staphylococcal toxic shock syndrome [63] or infectious mononucleosis [64]. It can manifest with a generalised pustular eruption [65], which can be follicular based [66].…”

Section: Hypersensitivity Syndromementioning

confidence: 99%

Impact of phenytoin therapy on the skin and skin disease

Scheinfeld¹

2004

Expert Opinion on Drug Safety

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Phenytoin (diphenylhydantoin; Dilantin), ALZA Corp.) is a highly effective and widely prescribed anticonvulsant agent used in the treatment of focal and tonic clonic generalised seizures. The side effects of phenytoin can occassionally engender significant morbidity. Phenytoin can induce generalised eruptions that include: a maculopapular exanthem, Stevens-Johnson syndrome, generalised exfoliative dermatitis, toxic epidermal necrolysis, vasculitis and fixed drug eruptions. Phenytoin is linked to a hypersensitivity syndrome that manifests with fever, rash and lymphadenopathy. Patients receiving phenytoin may develop pseudolymphoma or, rarely, malignant lymphoma and mycosis fungoides-like lesions. Rarer cutaneous side effects include drug-induced lupus, purple hand syndrome, pigmentary alterations and IgA bullous dermatosis. Phenytoin can effect clotting function and alter vitamin and mineral levels. Prenatal exposure to phenytoin may result in a spectrum of structural, developmental and behavioural changes, known as the fetal hydantoin syndrome. Patients who use phenytoin in the long-term commonly manifest with gingival hyperplasia, coarsening of the facies, and hirsutism.

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