Phenytoin Hypersensitivy Syndrome

Abstract

Anticonvulsant hypersensitivity syndrome (ACHS) has been reported to occur with use of phenytoin, carbamazepine, phenobarbitone and lamotrigine, but not valproate. It is a rare and potentially fatal complication. ACHS is indicated by the presence of a triad of characteristic clinical features — fever, rash and internal organ involvement. It is estimated to occur in about 1 in 1000 to 1 in 10,000 patients who are exposed to these anticonvulsants. Case scenario : A 27 year old female was taken to government hospital with complaints of diffuse edema over face, hands and legs, acute eczematous changes with oozing and crusting around the eyes, nose, neck, upper-limb and abdomen. Bilateral pitting edema was present. Erythematous macules present over both legs. Oral and genital mucosa is normal. The patient was abruptly stopped with all the medications and managed with corticosteroids and shifted over to Tablet. Clobazam 10mg. Discussion :   We present a case report of a patient with characteristic features of the phenytoin hypersensitivity  syndrome (PHS), after treatment with phenytoin. In addition to the clinical picture, and the absence of a septic focus, the probable response to corticosteroid therapy is compatible with the diagnosis of PHS. Conclusion :   The patient described in this report, presented to    hospital with severe skin lesions and features following the use of phenytoin. Such a rapidly fulminating form of PHS     has not been well documented. The early recognition of this  syndrome and the institution of corticosteroids may have been responsible for the favorable outcome in this case