Phenytoin Induced Myelosuppression in an Adult Epilepsy Patient : A Case Report

Abstract

Phenytoin is one of the most common and widely used anticonvulsant drug. The present case report explains the rare adverse effect of long term phenytoin treatment induced myelosuppression in a secondary care public hospital, Udhagamandalam, India. We report a case of 25 year old patient who was a known case of seizure for past 10 years. The patient was presented with complaints of two episodes of seizure, fever and abdominal pain to the intensive care unit. The patient was treated with intravenous fluids-dextrose normal saline and ringer lactate, intravenous routes of phenytoin, ciprofloxacin, metronidazole, ranitidine and tablet zinc. The patient's vital signs and blood parameters were monitored on a regular basis. The patient's blood pressure was fluctuating and blood parameters were found to be drastically reducing during the course of treatment with phenytoin. Blood transfusion was initiated in this patient for the treatment of myelosuppression due to which the blood parameters were seen normal during the discharge. In any patient presented with suspected drug induced myelosuppression, early diagnosis of cytopenia with a complete blood count is crucial. In such cases, appropriate symptomatic management along with timely withdrawal of drug remains the best option in current scenario. Being considered a classic antiepileptic, these kinds of serious haematological adverse effects of phenytoin on long term use is often overlooked. Reporting of these types of rare but potential adverse effects is necessary to create awareness among more clinicians.