Anticonvulsant hypersensitivity: an unfortunate case of triple exposure to phenytoin.
Anticonvulsant hypersensitivity manifests 2 to 12 weeks after patients start taking phenytoin, phenobarbital, or carbemazepine. The syndrome begins with fever followed by a rash that can progress to erythema multiforme, toxic epidermal necrolysis, and multi-organ system involvement. Other common manifestations include lymphadenopathy, facial edema, eosinophilia, and elevated transaminase levels. Anticonvulsant hypersensitivity can be fatal in 5% to 50% of patients if hepatic involvement or toxic epidermal necrolysis occurs. Most evidence regarding the etiology points to a genetically related defect in the detoxification enzyme. Early recognition is important in order to discontinue drug therapy. Continuity of care assists in prevention of re-exposure. Treatment includes supportive measures and steroids. All patients with anticonvulsant hypersensitivity should wear a medical identification bracelet.
Brown
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CE
St. Anthony Hospital Family Medicine Residency, Oklahoma, Oklahoma City 73102, USA.
Smith
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GD
Coniglione
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D000368:Aged; D000927:Anticonvulsants / Q000008:administration & dosage / Q000009:adverse effects*; D003266:Continuity of Patient Care; D004342:Drug Hypersensitivity / Q000209:etiology* / Q000473:pathology; D004636:Emergency Service, Hospital; D005194:Family Practice; D005260:Female; D006801:Humans; D010344:Patient Advocacy; D010672:Phenytoin / Q000008:administration & dosage / Q000009:adverse effects*; D012867:Skin / Q000473:pathology; D013226:Status Epilepticus / Q000188:drug therapy*
D000927:Anticonvulsants; D010672:Phenytoin