title: Lacking the 'protective label' of diabetes: Phenytoin-induced distal symmetrical peripheral neuropathy. A clinical case report.
abstract: This report documents an unusual case of distal symmetrical peripheral neuropathy (DSPN) in an otherwise healthy patient without diabetes mellitus (DM) presenting to a podiatric wound care clinic. The development of gas gangrene coupled with Charcot neuroarthropathic changes ultimately resulted in a potentially life-saving transmetatarsal (TMT) amputation. Causation of, or at least a contributor to, the DSPN was likely phenytoin usage for epileptic seizures. Long-term use of phenytoin can lead to axonal shrinkage and random clusters of nerve demyelination [1]. Clinical standards for DM-induced DSPN indicate that annual comprehensive neurological assessment to detect nerve function deterioration is warranted [2]. This can aid in identifying patients at high risk of diabetic foot ulceration. However, oftentimes, patients exhibiting medication-induced neuropathy are not assessed to determine severity of the neuropathy nor are they educated about ulcer prevention in the same manner as patients with DM. This report advocates for a standardized threshold of diagnostic and preventative investigation for neuropathy of all aetiologies; diabetic, traumatic, viral, medication-induced and idiopathic.
authors.affiliation: Discipline of Podiatric Medicine, College of Medicine Nursing & Health Sciences, Aras Moyola, National University of Ireland Galway, Ireland. Electronic address: a.mahon1@nuigalway.ie.
authors.forename: A M
authors.initials: AM
authors.lastname: Mahon
mesh_terms: D000671:Amputation, Surgical; D000927:Anticonvulsants / Q000009:adverse effects*; D004827:Epilepsy / Q000188:drug therapy; D016523:Foot Ulcer / Q000139:chemically induced*; D005738:Gas Gangrene / Q000139:chemically induced*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010523:Peripheral Nervous System Diseases / Q000139:chemically induced* / Q000150:complications; D010672:Phenytoin / Q000009:adverse effects*; D011552:Pseudomonas Infections / Q000209:etiology; D011550:Pseudomonas aeruginosa
chemical_list: D000927:Anticonvulsants; D010672:Phenytoin
keywords: Amputation; Charcot; Peripheral neuropathy; Phenytoin; Podiatry