Abstract

ANTICONVULSANT HYPERSENSITIVITY SYNDROME INDUCED BY PHENYTOIN – AN ATYPICAL PRESENTATION

Namratha M. V.* and Anuradha H. V.

ABSTRACT

Introduction: Anticonvulsant Hypersensitivity Syndrome (AHS) is an uncommon potential idiosyncratic drug induced reaction. It is commonly seen with aromatic antiepileptic drugs (phenytoin, carbamazepine and phenobarbital) characterized by rash (severe exanthematous rash with minimal or no mucosal involvement), fever, facial swelling, other signs of hypersensitivity (lymphadenopathy, eosinophilia, etc.,) following 2-4 weeks of drug therapy. Case description: A 59 year old male patient presented with seizure, for which he was prescribed with oral phenytoin 100 mg twice daily and levetiracetam 1g twice daily. After 15 days, patient developed peeling of skin all over the body, facial-periorbital edema and itching. Physical examination showed scaling and exfoliation of skin with diffuse erythema. Patient was managed as a case of anticonvulsant drug induced hypersensitivity syndrome and drugs were withdrawn. Patient recovered without any sequel by 4-5 weeks. As the patient did not had fever or systemic involvement, it was considered as “Atypical Anticonvulsant hypersensitivity Syndrome” Conclusion: The case illustrates the phenytoin otherwise an efficient and widely used antiepileptic drug is an agent capable of inducing adverse effect like drug hypersensitivity syndrome.

Keywords: Phenytoin, Hypersensitivity syndrome, Antiepileptic drugs.