Rare case of phenytoin induced acute generalized exanthematous pustulosis with cerebellar syndrome

Shingade, Pravin; Wankhede, Vaishali; Kataria, Pritam; Sonone, Nitin

doi:10.4103/0019-5154.127715

Cited by 8 publications

(3 citation statements)

References 7 publications

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“…Lung and bone marrow might also be involved, leading to respiratory failure and neutropenia, respectively [ 33 ]. One case with phenytoin-induced AGEP and cerebellar symptoms has been reported, while it is unknown whether cerebellar symptoms were related to the drug reaction or to phenytoin toxicity [ 34 ]. AGEP usually shows a mild course but high fever or cutaneous superinfection can complicate the process and lead to severe illness and sometimes life-threatening situations, especially in patients of poor general condition.…”

Section: Clinical Features and Variantsmentioning

confidence: 99%

Acute Generalized Exanthematous Pustulosis: Pathogenesis, Genetic Background, Clinical Variants and Therapy

Feldmeyer

Heidemeyer

Yawalkar

2016

IJMS

167

204

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Acute generalized exanthematous pustulosis (AGEP) is a severe, usually drug-related reaction, characterized by an acute onset of mainly small non-follicular pustules on an erythematous base and spontaneous resolution usually within two weeks. Systemic involvement occurs in about 20% of cases. The course is mostly benign, and only in rare cases complications lead to life-threatening situations. Recent studies highlight the importance of genetic variations in interleukin-36 receptor antagonist gene (IL-36RN) in the pathogenesis of this disease. The physiopathology of AGEP remains unclear, but an involvement of innate and acquired immune cells together with resident cells (keratinocytes), which recruit and activate neutrophils via production of cytokines/chemokines such as IL-17, IL-36, granulocyte-macrophage colony-stimulating factor (GM-CSF), tumor necrosis factor alpha (TNFα) and chemokine (C-X-C motif) ligand 8 (CXCL8)/IL-8, has been postulated. Treatment is based on the removal of the causative drug, supportive care, infection prevention and use of potent topical or systemic steroids.

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Section: Clinical Features and Variantsmentioning

confidence: 99%

Acute Generalized Exanthematous Pustulosis: Pathogenesis, Genetic Background, Clinical Variants and Therapy

Feldmeyer

Heidemeyer

Yawalkar

2016

IJMS

167

204

View full text Add to dashboard Cite

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“…1 Though the exact pathogenesis is unknown,it is thought to be a type IV hypersensitivity delayed reaction involving both CD4and CD8 cells. 7 The most important differential diagnosis in these patients is pustular psoriasis. This can be differentiated from AGEP on the basis of evolution of skin lesion, history of drug intake and of course histopathology.…”

Section: Discussionmentioning

confidence: 99%

Acute generalized exanthematous pustulosis secondary to Valproate: An uncommon cutaneous reaction of a common drug

Sahu¹,

Sahoo²,

Dayal³

et al. 2015

J YOUNG PHARM

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Objective: There are various adverse drug reaction (ADR) associated with pharmacological therapy that differ in clinical presentation, prognosis and therapy. Among these, cutaneous eruptions are the most common type of all ADRs.Theclinical presentation of cutaneous drug eruptions ranges from common transient and benign erythema to the most severe forms such as Steven-Johnson syndrome (SJS), Toxic epidermal necrolysis (TEN). Acute generalized exanthematous pustulosis (AGEP) is a rare cutaneous drug reaction accounting for 1-5 cases/1,000,000 per year. Antibiotics like β-lactams and macrolides are the usual offending agents. Among anticonvulsants-carbamazepine, phenobarbital and phenytoin are commonly associated with AGEP. Sodium valproate is relatively free from cutaneous drug reaction. Thus, we hereby, report a rare case of AGEP in a 24 years old male, reaction following valproate intake used to control post traumatic seizure.Key words: Acute generalized exanthematous pustulosis, Valproate, Adverse drug reaction.Key message: Now-a-days valproate is being widely used in patients of neurosurgery, neurology and psychiatry. AGEP is a quite rare adverse drug reaction produced by valproate. Thus, patients taking valproate if develops fever along with non-follicular pustules then, AGEP should be kept as a differential diagnosis and the offending agent to be replaced with some safer drug immediately to avoid unnecessary morbidity.

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“…Valproic acid also reduces alkaline phosphatase and hydroxyproline in lumbar spine (40). Skin reaction to at least one AED such as carbamazepine, phenytoin, lamotrigine or oxcarbazepine has been reported in 30 out of 300 patients; one of them developed Stevens-Johnson syndrome (34,(41)(42)(43).…”

Section: Discussionmentioning

confidence: 99%

Evidence-Based Pharmacotherapy of Epilepsy

2014

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Background: Due to the narrow therapeutic window of the AEDs prescription, their side effects and efficacy are the most important items that should be considered in epileptic patients. Objectives: This study aimed to investigate evidence-based pharmacotherapy in epileptic patients. Patients and Methods: Data were collected Cross-sectionally from patients (n = 24) registered at Kashani Epilepsy Ward in Isfahan. Demographic, clinical, hematology and biochemical data were recorded in d-base and analyzed using SPSS application for windows. Results: The frequency of polypharmacy was 79% in which 50% of epileptic patients received 3 to 4 AEDs. The onset of seizure was under 16 years old in 70% of patients. Fourteen varieties of AEDs were used, among them valproic acid (Depakote) was the most administered drugs. Prescriptions of two patients consisted of 4 and 6 AEDs: patient with code No. 575 (carbamazepine, topiramate, clobasam, lamotrigine) and another one with code No. 587 (oxcarbamazepine, phenytoin, gabapentin, valproic acid, clonazepam, lamotrigine). Red blood cell counts, hemoglobin and hematocrit in patients under more than one drug treatment were significantly lower than patients with AED monotherapy. Conclusions: AEDs are well-recognized to control seizure attacks. In clinical practice, the older generation of AEDs such as carbamazepine (CBZ), valporic acid (VPA), phenytoin (PHT), topiramate (TOP) and lamotrigine (LAMO) might need monitoring serum levels. Nonrational polypharmacy in terms of simultaneous using of both AEDs inducer and inhibitor could cause sedation, dizziness, and cognitive adverse effects. Further studies are needed to confirm these associations. Finally, to avoid polypharmacy that could arise side effects, a sufficient intervention for each AED to decide on its continuation, interruption or the number of drugs should be attempted. Combinations based on CBZ + VP, VP + TOP, CBZ + TOP, VP + LAMO, and TOP + LAMO could cause pharmacokinetic interactions.

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Rare case of phenytoin induced acute generalized exanthematous pustulosis with cerebellar syndrome

Cited by 8 publications

References 7 publications

Acute Generalized Exanthematous Pustulosis: Pathogenesis, Genetic Background, Clinical Variants and Therapy

Acute Generalized Exanthematous Pustulosis: Pathogenesis, Genetic Background, Clinical Variants and Therapy

Acute generalized exanthematous pustulosis secondary to Valproate: An uncommon cutaneous reaction of a common drug

Evidence-Based Pharmacotherapy of Epilepsy

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