Phenytoin hypersensitivity syndrome with fatal evolution

Abstract

were made at 48 and 96 h according to the ICDRG (International Contact Dermatitis Research Group) guidelines. The results are shown in Table 1. The positive reactions to wool alcohols, fragrance mix, colophony, and balsam of Peru had past relevance, but the positive reaction to black rubber mix did not. Six weeks later, we retested the patient with PG (0.5%, 1% and 2% aq.) showing positive results at D2 with PG 1% and 2% aq. We also performed a ROAT (repeated open application test) with PG 2% aq. (two applications per day) in the antecubital fossa. After 2 days, an eczematous reaction appeared on the treated area. Funk & Maibach classify skin reactions to PG into four mechanisms: irritant contact dermatitis, allergic contact dermatitis, nonimmunologic contact urticaria, and subjective or sensory irritation (2). The distinction between irritant and allergic reactions associated with PG application remains unclear. Furthermore, the irritation threshold of PG and the optimal standard concentration in patch tests are not well established. Usually a PG concentration of 1±10% aq. is recommended for patch tests in order to avoid irritation (2, 3). However, some authors recommend raising the standard PG concentration in patch tests to 20% and in doubtful cases even higher (50%) (4, 5). True allergic sensitization to PG should be con®rmed by repeated patch testing, serial dilutions, usage tests/ROAT, or oral challenge tests (in certain cases). Data on the incidence 2. Funk JO, Maibach HI. PG dermatitis:re-evaluation of an old problem. Contact

Anticonvulsant hypersensitivity syndrome associated with reactivation of cytomegalovirus

“…The phenytoin hypersensitivity syndrome is characterized by maculopapular rash and exfoliative dermatitis, high fever, hepatic failure, lymphadenopathy and leucocytosis with eosinophilia, typically developing within 3–6 weeks from the start of treatment 1–4,10 , 11 . In our patient, the characteristic reactions developed 25 days after the patient was started on phenytoin.…”

Pediatric Fatality Due to Anticonvulsant Hypersensitivity Syndrome

“…TO THE EDITOR: Anticonvulsant hypersensitivity syndrome (AHS) is an idiosyncratic reaction to aromatic anticonvulsants that can result in severe multiorgan dysfunction and death. 1,2 To our knowledge, this is the first report of a fatal case of AHS in a pediatric patient in Taiwan.…”

Anticonvulsant hypersensitivity syndrome

“…However, its true incidence is unknown due to variable presentations, lack of consensus regarding a standardised name and inaccurate reporting. This rare adverse event can result in death 3 …”