Phenytoin Induced Drug Reaction With Eosinophilia and Systemic Symptoms Syndrome: A Clinical Case Report

Varghese, Arshamol; Alosious, Aaja; Thomas, Rimisha; Surendran, Kavya; Vilapurathu, Jobin Kunjumon

doi:10.1177/08971900221116686

Cited by 2 publications

(3 citation statements)

References 16 publications

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“…Mucocutaneous drug reactions can result from both topical and systemic administrations of the agents. These drug reactions can mimic traumatic injuries (Table 1) [3][4][5][6][10][11][12][13][14][15][16][17][18][19]. The three patients described in this article developed cutaneous drug reactions that mimicked traumatic injuries; the assessment of their clinical features, without obtaining additional medication history, might have resulted in the misinterpretation of their etiology.…”

Section: Discussionmentioning

confidence: 99%

“…The onset is within three weeks to three months after starting the drug; there is fever, lymphadenopathy, and at least one internal organ system involved, and blood abnormalities may include lymphocytosis, eosinophilia, and thrombocytopenia. [10,11] Assault Irbesartan…”

Section: Dressassociated Phenytoinmentioning

confidence: 99%

“…Acute swelling of the face can occur after the initiation of antiepileptic drugs. Dramatic facial swelling, with marked edema of the eyelids, resulting from phenytoin-associated drug reaction with eosinophilia and systemic symptoms can mimic the morphologic appearance of a severe assault to the face [10,11]. Albeit less common, marked facial swelling has developed and persisted after the initiation of the antihypertensive agent irbesartan [12].…”

Section: Elder Abuse Bruise Tetracyclinesmentioning

confidence: 99%

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The Cutaneous Manifestations of Drug Reactions Can Mimic Traumatic Injuries: Case Reports and the Potential Role of Forensic Dermatology

Cohen

2023

Cureus

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The evaluation of the skin of the decedent is an essential component of the assessment by the forensic pathologist or the medical examiner. Age-associated cutaneous changes, primary diseases of the skin, and systemic conditions with mucocutaneous manifestations can be present. Importantly, several dermatoses can be misinterpreted for traumatic injuries; specifically, adverse reactions to medications can mimic assault, burns, elder abuse, and mutilation or torture. A male with corticosteroid-induced dermatitis mimicking an acute burn is described. A female with thalidomide embryopathy is reported with extensive deformities of her hands and feet with multiple absent digits mimicking a severe injury resulting from mutilation or torture. Another female is described who had hydroxychloroquine-associated hyperpigmentation; her physician misinterpreted the cutaneous hyperpigmentation as bruises and notified Adult Protective Services. Reactions to medications can also mimic assault, burns, and elder abuse. Drug reaction with eosinophilia and systemic symptoms (particularly when associated with phenytoin) can mimic assault. Albeit rarely, the antihypertensive irbesartan can result in dramatic edema of the face and eyelids similar to that observed following an assault. Drug-induced erythema multiforme can mimic a localized burn, and Stevens-Johnson syndrome or vancomycin infusion reaction can mimic an extensive burn. Several medications can mimic bruising observed in victims of elder abuse; they include amiodarone, arsenic, and tetracyclines (such as minocycline and doxycycline). In summary, an important aspect of the forensic evaluation during an autopsy includes a complete cutaneous examination; to aid in differentiating medication-associated dermatoses that can mimic traumatic injury, the evaluation of the decedent by a forensic dermatologist may be helpful to establish the etiology of observed skin changes.

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