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Year : 1990  |  Volume : 56  |  Issue : 1  |  Page : 54-55

Exfoliative dermatitis and non-fatal hepatitis induced by phenytoin

Correspondence Address:
S D Choudhary

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A 15 year old boy having epilepsy developed exfoliative dermatitis hepatitis accompanied by fever, lymphadenopathy, facial edema and eosinophilia, three weeks after the regular 'intake of phenytoin. He was treated with systemic corticosteroids which prevented the fatal termination.

Keywords: Phenytoin, Exfoliative dermatitis, Hepatitis

How to cite this article:
Choudhary S D, Jain V Y, Dixit V B, Sen R. Exfoliative dermatitis and non-fatal hepatitis induced by phenytoin. Indian J Dermatol Venereol Leprol 1990;56:54-5

How to cite this URL:
Choudhary S D, Jain V Y, Dixit V B, Sen R. Exfoliative dermatitis and non-fatal hepatitis induced by phenytoin. Indian J Dermatol Venereol Leprol [serial online] 1990 [cited 2020 May 25];56:54-5. Available from: http://www.ijdvl.com/text.asp?1990/56/1/54/3484

The toxicity of phenytoin usually occurs 1-3 weeks after starting the therapy and consists of a characteristic skin eruption, facial oedema, fever, tender and generalised lymphadenopathy, diffuse erythema of the oral mucosa, and atypical lymphocytes and/or eosinophilia.[1],[2] Liver function abnormalities have been reported either as jaundice or changes in the liver chemistry.[3],[4] The type of lymphadenopathy and even the pathological features of lymph nodes may suggest a lymphoma; therefore this has also been classified as a pseudolymphoma.[5] An immunological basis has been postulated in this entity, though the exact etiopathogenesis of this reaction is unknown. Cutaneous vasculitis and mycosis fungoides type of histopathological changes have been reported in the skin lesions.[6],[7] Exfoliative dermatitis with fatal or non-fatal hepatitis and periarteritis nodosa though rare, have been reported due to phenytoin hypersen­sitivity.[3],[4],[8] We are reporting our first case of exfoliative dermatitis with non-fatal hepatitis due to phenytoin hypersensitivity.

  Case Report Top

A 15-year-old boy, with epilepsy for two years and receiving phenytoin 300 mg per day for the last 4 weeks, developed a generalized erythematous eruption and high grade con­tinuous fever for the last seven days. The eruption was papulo-vesicular which desqua­mated in the next three days to change to exfolia­tive dermatitis. There was generalized, discrete, - tender lymphadenitis. Conjunctival and oral mucosae were deeply congested. Liver was tender and palpable 3 cm below the costal margin. There was no jaundice. Routine investi­gations revealed hemoglobin 11 gm%, total leucocytic count 9700/mm 3, eosinophils 30%, polymorphs 3 %, lymphocytes 22% and monocytes 13%. Peripheral blood film showed no abnormal cells. SGOT and SGPT were 70 iu and 60 in respectively. Serum bilirubin and serum proteins were within normal limits. ASO titre was less than 200 Todd units. Throat swab showed normal flora. Blood culture for enteric and pyogenic organisms was sterile. Bone marrow examination revealed non-specific reactive changes. Lymph node aspiration from an inguinal lymph node showed no abnormal cells. Biopsy of a skin lesion revealed spongiosis with intra-epidermal vesiculation and patchy exocytosis with no specific pathology in the dermis. Biopsy of an enlarged cervical lymph node showed reactive changes. Phenytoin was stopped immediately and the patient was put on phenobarbitone 60 mg/day and prednisolone 30 mg/day. He responded well to this treatment. The dose of prednisolone was tapered off gradually and ultimately stopped. However, phenobarbitone was continued to control the seizures.

  Comments Top

The patient developed exfoliative dermatitis and non-fatal hepatitis along with other features of phenytoin hypersensitivity reaction. Early recognition of this reaction is important as this may prove fatal in case phenytoin is not stopped immediately. Its continuous use may result in exfoliative dermatitis along with fatal hepatitis or periarteritis nodosa.[3],[4],[5],[6],[7],[8] Our case turned out to be non-fatal as the drug was withdrawn immediately.

  References Top

1.Stanley J and Fallon-Pellicci V : Phenytoin hyper­sensitivity reaction, Arch Dermatol, 1978; 114 1350-1353.  Back to cited text no. 1    
2.Chariesworth EN : Phenytoin induced pseudo­ lymphoma, Arch Dermatol, 1977; 113 : 477-480.  Back to cited text no. 2    
3.Gropper AL : Diphenylhydantoin sensitivity Report of fatal case with hepatitis and exfoliative dermatitis, N Eng J Med, 1956; 254 : 522-523.  Back to cited text no. 3    
4.Chaiken BH, Goldberg BI and Segal JP : Dilantin sensitivity : A report of a case of hepatitis with jaundice, pyrexia and exfoliative dermatitis, N Eng J Med 1950; 242 : 897-898.  Back to cited text no. 4    
5.Saltzman SL and Ackerman LV : Lymphadenopathy induced by anticonvulsant drugs and mimicking clinically and pathologically malignant lymphomas, Cancer, 1959; 12 :164-182.  Back to cited text no. 5    
6.Targan SR, Chassin MRG and Guze LB : Dilantin induced disseminated intravascular coagulation with purpura fulminans, Ann Int Med, 1975;83: 227-230.  Back to cited text no. 6    
7.Schreiber MM and McGregor JG : Pseudolym­phoma syndrome : A sensitivity to anticonvulsant drugs, Arch Dermatol, 1968; 97 : 297-300.  Back to cited text no. 7    
8.Van Wyk JJ and Hoffmann CR : Periarteritis nodosa : A case of fatal exfoliative dermatitis result­ing from dilantin sodium sensitization, Arch Int Med, 1948; 81 : 605-611.  Back to cited text no. 8    


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