Fatal phenytoin-induced thrombocytopaenia in a neurosurgical patient

Thorning, Geoff; Raghavan, Kalyani

doi:10.1017/s0265021507000750

Cited by 7 publications

(9 citation statements)

References 6 publications

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“…This immunologic reaction induces platelet-specific drug-dependent antibody, which recognizes glycoprotein IIb-IIIa or less commonly Ib-IX membrane glycoprotein complexes. The formation of metabolites and then the binding and subsequent immune response would account for the delay in the onset of immune reactions and the onset of clinical manifestations of thrombocytopenia [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

“…The mean delay in the onset of immune-mediated thrombocytopenia is reported to be one to three weeks following exposure to the drug. Few authors report the time of onset to vary from two days to two years after phenytoin initiation [ 6 ]. This case presented with a platelet count of 15 x 10 9 /L, suggestive of severe thrombocytopenia after three months of exposure to phenytoin, which improved on discontinuation of the drug therapy.…”

Section: Discussionmentioning

confidence: 99%

“…Phenytoin-induced thrombocytopenia usually occurs within one to three weeks after exposure to the drug, but in some cases, the time of onset may vary from two days to two years after initiation of phenytoin treatment [ 6 ]. We report a case of phenytoin-induced thrombocytopenia that presented with multiple oral hemorrhagic manifestations and one purpuric spot in the left upper arm three months after initiation of phenytoin.…”

Section: Introductionmentioning

confidence: 99%

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Significance of Oral Manifestations in the Diagnosis of Severe Phenytoin-Induced Thrombocytopenia: A Rare Case

Gangadaran¹,

Balasubramanian²

2023

Cureus

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Phenytoin is a commonly used anticonvulsant drug for the prophylaxis of generalized tonic-clonic seizures, partial seizures, and neurosurgery-related seizure prevention. Phenytoin-induced thrombocytopenia is a rare but life-threatening condition. Close monitoring of blood counts may be necessary for patients receiving phenytoin, as delay in diagnosis or withdrawal of the drug can be life-threatening. Clinical manifestations of phenytoin-induced thrombocytopenia are usually reported within one to three weeks after drug initiation. In this article, we report a unique case of drug-induced thrombocytopenia that manifested as multiple hemorrhagic lesions in the oral mucous membrane three months after phenytoin initiation.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Significance of Oral Manifestations in the Diagnosis of Severe Phenytoin-Induced Thrombocytopenia: A Rare Case

Gangadaran¹,

Balasubramanian²

2023

Cureus

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“…This notable depression in the enzyme level was detectable within 24 to 72 hours post-injection [12]. Another contributory drug in inhibiting epoxide hydrolase is cimetidine, a class of H2-receptor antagonist, which has been discussed and reported in studies as well [6,13,14].…”

Section: Discussionmentioning

confidence: 99%

“…Unfortunately, the patient died 5 days after the second operation due to brainstem compression [13].…”

Section: Discussionmentioning

confidence: 99%

Phenytoin Seizure Prophylaxis Therapy Resulting in Severe Thrombocytopenia After Brain Tumor Debulking Surgery

2020

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Challenging differential diagnosis Background:Phenytoin is an antiepileptic drug that is usually prescribed as a prevention treatment for tonic-clonic seizures or partial seizures, and as a prophylaxis for the neurosurgical related seizures. Phenytoin administration has several drawbacks; one drawback phenytoin-induced thrombocytopenia, which is a rare and significant adverse event. We report a rare adverse event after phenytoin prophylaxis therapy after a brain tumor debulking surgery, which resulted in severe unpredicted thrombocytopenia. Case Report:A 40-year-old male with no known health problems started to have an on/off headaches and loss of memory. Clinical investigations revealed a right frontal brain lesion. On the first day of admission, the patient was managed on neurosurgical seizure prophylaxis therapy of 100 mg intravenous phenytoin every 8 hours and 4 mg oral dexamethasone every 6 hours. On the fifth day of hospital admission, the patient underwent tumor debulking surgery. Twenty-four hours post-surgery, the patient's platelet level dropped to 26×10 9 /L. Severe thrombocytopenia was managed first by transfusion of 17 units of platelets and by cessation of intravenous phenytoin plus the starting of 500 mg levetiracetam orally twice daily. Further management included infusion of 34 grams (0.4 g/kg) intravenous immunoglobulin (IVIG) over 5 days. Five days later, the patient gradually recovered with a platelet count of 239×10 9 /L. Conclusions:Phenytoin-induced thrombocytopenia is considered a rare event, but it has life-threatening consequences. The first and cornerstone management of this event is the cessation of phenytoin, followed by consideration of appropriate management based on the level of thrombocytopenia severity, and avoiding concomitant therapy of phenytoin and the use of dexamethasone as neurosurgical-related seizure prophylaxis.

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Current awareness: Pharmacoepidemiology and drug safety

2008

Pharmacoepidemiology and Drug

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In order to keep subscribers up‐to‐date with the latest developments in their field, John Wiley & Sons are providing a current awareness service in each issue of the journal. The bibliography contains newly published material in the field of pharmacoepidemiology and drug safety. Each bibliography is divided into 20 sections: 1 Reviews; 2 General; 3 Anti‐infective Agents; 4 Cardiovascular System Agents; 5 CNS Depressive Agents; 6 Non‐steroidal Anti‐inflammatory Agents; 7 CNS Agents; 8 Anti‐neoplastic Agents; 9 Haematological Agents; 10 Neuroregulator‐Blocking Agents; 11 Dermatological Agents; 12 Immunosuppressive Agents; 13 Autonomic Agents; 14 Respiratory System Agents; 15 Neuromuscular Agents; 16 Reproductive System Agents; 17 Gastrointestinal System Agents; 18 Anti‐inflammatory Agents ‐ Steroidal; 19 Teratogens/fetal exposure; 20 Others. Within each section, articles are listed in alphabetical order with respect to author. If, in the preceding period, no publications are located relevant to any one of these headings, that section will be omitted.

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Fatal phenytoin-induced thrombocytopaenia in a neurosurgical patient

Cited by 7 publications

References 6 publications

Significance of Oral Manifestations in the Diagnosis of Severe Phenytoin-Induced Thrombocytopenia: A Rare Case

Significance of Oral Manifestations in the Diagnosis of Severe Phenytoin-Induced Thrombocytopenia: A Rare Case

Phenytoin Seizure Prophylaxis Therapy Resulting in Severe Thrombocytopenia After Brain Tumor Debulking Surgery

Current awareness: Pharmacoepidemiology and drug safety

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