Phenytoin-induced Stevens–Johnson syndrome with myocarditis: a rare case report

Abstract

Stevens–Johnson syndrome (SJS) is an acute life-threatening mucocutaneous reaction caused by excessive necrosis and detachment of the epidermis. It is commonly drug induced and phenytoin is a common precipitant. Phenytoin, an antiepileptic drug, is also known to cause myocarditis. Phenytoin causing both myocarditis and SJS in the same patient is very rare and can lead to increased morbidity and mortality. Here, we describe the case of a 43-year-old male who developed SJS and myocarditis secondary to phenytoin. In spite of aggressive resuscitative efforts, the patient could not be revived. Thus, a combination of myocarditis with SJS increases the mortality and should be considered in patients with SJS secondary to phenytoin and associated shock.

Epidemiological Impact of Myocarditis

“…Toxic myocarditis may be triggered by numerous agents. Prescribed drugs such as dobutamine, phenytoin [ 42 ], antibiotics (e.g., ampicillin, azithromycin, cephalosporins and tetracyclines), psychiatric medications (tricyclic antidepressants, benzodiazepines and clozapine) [ 43 ], recreational/illicit drugs (e.g., methamphetamine or cocaine) [ 44 ], heavy metals (copper, lead and arsenicals) and antineoplastic agents (e.g., anthracyclines, cyclophosphamide, 5-fluorouracil and tyrosine kinase inhibitors) are known etiologies of myocarditis [ 43 ]. With the increasing use of Immune-Checkpoint Inhibitors (ICIs) to treat a variety of cancers, reports of lethal myocarditis as potential adverse effects of therapy have increased.…”

Autoimmunity in Acute Myocarditis: How Immunopathogenesis Steers New Directions for Diagnosis and Treatment

“…Other infectious causes of myocarditis include Trypanosoma cruzi-a protozoan parasite causing Chagas disease, and bacteria such as group A streptococcus. An often overlooked cause for myocarditis is hypersensitivity to medications (such as dobutamine or phenytoin [9]) or drugs (such as methamphetamine or cocaine [10]). Myocarditis may also be found on endomyocardial biopsies (EMBs) amongst patients with stress-induced or Takotsubo cardiomyopathy [11].…”