Phenytoin hypersensitivity reaction

Abstract

A clinically characteristic hypersensitivity reaction to phenytoin occurred in two patients three to four weeks after they started phenytoin therapy. It consisted of a characteristic rash, fever, tender generalized lymphadenopathy, leukocytosis with atypical lymphocytes, and eosinophilia. One patient had liver function abnormalities suggestive of hepatitis, as have most previously reported cases. The rash was pruritic and generalized; it consisted of irregular, ill-defined macular erythema in patches with superimposed follicular papules and massive edema of the face and periorbital region. Facial edema is characteristic of this syndrome. In one case the rash progressed to include follicular pustules and resolved with superficial desquamation. Histopathologic specimens from both cases showed a dense, superficial lymphohistiocytic infiltrate in the dermis and epidermal spongiosis. Intraepidermal pustules were present in one patient. The importance of recognizing this syndrome is stressed because it is potentially fatal.

Acute Generalized Exanthematic Pustulosis: A Case and an Overview of Side Effects Affecting the Skin Caused by Celecoxib and Other COX-2 Inhibitors Reported So Far

“…Neither were drug lymphocyte transformation tests. In AGEP, the interval between administration of the drug and beginning of the skin eruption varies from a few hours to 15 days [2, 3]. The cutaneous eruption often begins in the face and/or intertriginous areas and disseminates within a few hours, and normally there is a more pronounced underlying erythema to see as it was in our case [4].…”

Acute Generalized Exanthematous Pustulosis due to Doxycycline

“…The eruption is more frequently pre cipitated by drugs [1][2][3][6][7][8][9][10][11][12][13][14][15][16][17][18][19], although other causative agents [3,7,12,17] have been incriminated (table 2).…”

Immunological Adverse Effects of Anticonvulsants

“…It may be part of a systemic hypersensitivity reaction with Drug S4ety 8 (3) 1993 fever, eosinophilia, skin rash, arthritis, hepatic and/ or renal involvement (Chennebault et al 1982;Danno et al 1989;Flowers et al 1987;Haruda 1979;Josephs et al 1980;Matson et al 1985;McCarthy et al 1979;Michael & Mitch 1976;Prosser & Lander 1987;Smythe & Umstead 1989;Stanley & Fallon-Pellicci 1978;Tomsick 1983). Interestingly, Gennis et al (1991) described a familial occurrence of hypersensitivity to phenytoin.…”