Phenytoin induced toxic epidermal necrolysis: A case report (original) (raw)

Skin Reactions Associated to Phenytoin Administration: Multifactorial Cause

Clinical Pharmacology & Biopharmaceutics, 2014

Purpose: Cutaneous reactions can be associated with phenytoin administration. Such reactions can be explained by the formation of reactive species (arene oxide and quinones) capable of interacting covalently with cell macromolecules during phenytoin metabolism. Enzymes involved in reactive species detoxification are polimorphically expressed in humans. A genetic abnormality leading to a defective microsomal epoxidase hydrolase (main detoxification enzyme) activity could be one of the causes leading to this kind of adverse effect, but not the only one. The purpose of this study was to give a deeper insight into the main causes leading to skin reactions.

Drug induced toxic epidermal necrolysis: two case reports

Cases journal, 2009

IntroductionAmong the various drug induced dermatological entities toxic epidermal necrolysis and Stevens-Johnson’s syndrome occupy a primary place in terms of mortality. Prompt recognition of these conditions, immediate drug withdrawal and institution of appropriate treatment plays a vital role in reducing mortality. Drugs are by far the most common cause of toxic epidermal necrolysis, in which large sheets of skin are lost from the body surface making redundant the barrier function of the skin, with its resultant complications. The use of systemic corticosteroids in the treatment of toxic epidermal necrolysis has always been controversial, some consider corticosteroids life-saving while others believe that they increase mortality.Case presentationWe describe two cases of drug-induced toxic epidermal necrolysis, a male and a female, both caucasoids of Pakistani origin, one treated without any steroids and the other with them, who made complete recovery without any major complications or sequelae.ConclusionThe administration of systemic corticosteriods did not cause any major changes in outcome in our cases.

Toxic Epidermal Necrolysis After Phenytoin Usage in a Brain Trauma Patient

Journal of Neurosurgical Anesthesiology, 2002

Toxic epidermal necrolysis is a drug-induced, rare, but life-threatening skin eruption. The main differential diagnoses are drug-induced erythema (hypersensitivity syndrome), acute graft-versus-host disease, staphylococcal scalded skin syndrome, and toxic shock syndrome. Because the therapy for toxic epidermal necrolysis and acute graft-versus-host disease differs largely from the others, it is necessary to make an accurate diagnosis. In addition to a detailed medical history, skin biopsy is mandatory because the skin eruptions are not always unequivocal. Discontinuation of the causing agent is crucial, and treatment in specialized intensive care units or burn units is supportive. Currently there is no specific treatment for toxic epidermal necrolysis. Advantages from corticosteroids, plasmapheresis, intravenous immunoglobulin, cyclophosphamide, cyclosporin, and N-acetylcysteine still remain to be established by controlled trials, or have failed to prove a benefit (thalidomide). The patient presented here demonstrates the difficulties in diagnosing toxic epidermal necrolysis in a critically ill patient. A short overview of the pathogenesis and the management of toxic epidermal necrolysis is provided.

Phenytoin Toxicity: A Case Report

Journal of Young Pharmacists, 2015

Background: Phenytoin is a commonly used sedative antiepileptic medication in many countries. It is used against tonic-clonic and complex partial seizures. Phenytoin is reported to cause a range of deleterious and erratic side effects at therapeutic and toxic doses. Case report: An eighteen year old female presented with ataxia, nystagmus, gingival hypertrophy, nodular skin lesions and hirsutism while she was on treatment with oral phenytoin at 200 mg once daily since the past five years for seizures. Based on the presenting signs and symptoms, her condition was diagnosed as phenytoin induced toxicity. The symptoms improved significantly after the offending drug was withdrawn. Alternatively she was started on oral carbamazepine. Naranjo and WHO causality assessment was done, indicating a probable relationship between the patient's symptoms and her use of phenytoin. Conclusion: This case report and review highlights the adverse drug reactions of phenytoin and the need of regular monitoring in patients on long term therapy.

A 26-year-old man with ocular complications after adverse reaction to phenytoin

Digital journal of ophthalmology : DJO, 2016

A 26-year-old black man was admitted to the Burn Unit of Hamilton General Hospital, Ontario, following an adverse drug reaction to phenytoin. He was diagnosed with toxic epidermal necrolysis (TEN) and Ophthalmology was consulted to assess for ocular complications (Figure 1). The Score of Toxic Epidermal Necrosis (SCORTEN) for this patient was 2 (SCORTEN is a validated severity-of-illness score that is predictive of mortality; scores range from 0-7, with 2 corresponding to a 12.1% mortality rate), because he was <40 years of age, had no associated malignancy, had a heart rate of >120 beats/minute, no electrolyte abnormalities (blood urea nitrogen, serum glucose, or serum bicarbonate), and a detached body surface of >10%. 1 He had no comorbidities. His medical history was remarkable for epilepsy. The patient had 85% of his body covered in a thin vesicular slightly blistering rash. His systemic involvement included oral and orbital edema and ulceration of his lips, oral mucosa, scrotum, glans, and upper right chest. Differential Diagnosis Toxis epidermal necrolysis (TEN), a very rare and potentially fatal skin disorder, is a severe form of Stevens-Johnson syndrome (SJS). 4 It is usually triggered by immunological reaction caused by drugs taken for the first time. 2 It was suspected in this patient because he lacked an infection source and symptoms occurred after

Drug-induced toxic epidermal necrolysis: A rare case report

IP innovative publication pvt. ltd , 2019

Stevens-Johnson syndrome may be a rare, severe disease of the mucous membranes or skin and toxic epidermal necrolysis may be a serious type of some life-threatening condition. Toxic epidermal necrolysis (TEN) and Stevens - Johnson syndrome (SJS) area severe adverse connective tissue drug reactions. Both of them are rare with TEN and SJS affecting about 1 or 2/1,000,000 people annually. Toxic epidermal necrolysis (TEN) conjointly referred to as Lyell’s syndrome may be a widespread deadly severe connective tissue disease that causes extensive detachment of the mucous membrane and skin. Several etiological factors are notable for TEN, the foremost common being the adverse drug reactions. They are characterized by erythema, epidermal detachment presenting as blisters, and areas of denuded skin. Medication is assumed or known as the main reason for SJS/TEN in most cases.