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

Gangadaran, Vinodh; Balasubramanian, Manonmani

doi:10.7759/cureus.37585

Cited by 2 publications

(3 citation statements)

References 11 publications

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“…There have been reports of phenytoin-induced thrombocytopenia in patients who received phenytoin for the treatment or prevention of seizure disorders. Commonly, phenytoin-induced thrombocytopenia begins 1-90 days after administration, and the time of platelet recovery is 3-21 days after phenytoin discontinuation [4,[6][7][8][9][10][11][12][13].…”

Section: Figure 1: Relationship Between Platelet Count and Drug Admin...mentioning

confidence: 99%

Phenytoin-Induced Severe Thrombocytopenia: A Case Report

Maneerot,

Saelue,

Sangiemchoey

2024

Cureus

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Phenytoin is a commonly prescribed antiepileptic medication for the prevention and treatment of tonic-clonic or partial seizures. Thrombocytopenia is a rare and serious adverse effect of phenytoin. This case report presents the case of a patient with severe thrombocytopenia induced by phenytoin for the treatment of tonic-clonic seizures. A 63-year-old male received 300 mg/day of phenytoin for the treatment of tonic-clonic seizures. Seven days after receiving the first dose of phenytoin, he was diagnosed with severe thrombocytopenia (platelet count 44 x 10 9 /L) without hemorrhage. Phenytoin was discontinued, and seizures were controlled with levetiracetam. Seven days after stopping phenytoin, his daily platelet count improved from 44 to 177 x 10 9 /L. The Naranjo algorithm score of 7 was at a probable level for phenytoin-induced thrombocytopenia. Thrombocytopenia is a serious adverse drug reaction that can result in life-threatening bleeding. Phenytoin-induced thrombocytopenia commonly begins 1-90 days after administration, and the recovery time is 3-21 days. The potential mechanism of phenytoin-induced thrombocytopenia is drug-induced immune thrombocytopenia. Drugs that enhance the concentration of phenytoin epoxide may be a contributing factor in phenytoin-induced thrombocytopenia. Phenytoin-induced thrombocytopenia is a rare but serious hematological complication. It should be recognized early, particularly in patients with a high risk of hemorrhage or concurrently with medications that increase phenytoin epoxide. Regularly consecutive complete blood count tests may be essential in order to detect an early decrease in platelet count in these patients.

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Section: Figure 1: Relationship Between Platelet Count and Drug Admin...mentioning

confidence: 99%

Phenytoin-Induced Severe Thrombocytopenia: A Case Report

Maneerot,

Saelue,

Sangiemchoey

2024

Cureus

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“…6 Currently, more studies are focusing on the issue of DIT, highlighting the severity of thrombocytope-nia in clinical practice. [7][8][9][10] A study has indicated that DIT occurs in 15% to 58% of patients admitted to intensive care units. 11 The primary challenge in the management of DIT is identifying the specific drug that contributed to thrombocytopenia.…”

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confidence: 99%

“…Currently, more studies are focusing on the issue of DIT, highlighting the severity of thrombocytopenia in clinical practice 7‐10 . A study has indicated that DIT occurs in 15% to 58% of patients admitted to intensive care units 11 .…”

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confidence: 99%

An Updated Comprehensive Pharmacovigilance Study of Drug‐Induced Thrombocytopenia Based on FDA Adverse Event Reporting System Data

Kunyu,

Shuping,

Chang

et al. 2024

The Journal of Clinical Pharma

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Drug‐induced Thrombocytopenia (DIT) deserved both clinical and research attention for the serious clinical consequences and high proportion.The current study aimed to perform a comprehensive pharmacovigilance analysis of DIT reported in the FDA Adverse Event Reporting System (FAERS) database, with a particular focus on drugs associated with Thrombocytopenia events. A disproportionality analysis of DIT was conducted using reports submitted to the FARES from January 2004 to December 2022. The algorithms of Information Component (IC) and Reporting Odds Ratio (ROR) were applied to identify the association between target drugs and DIT events. A total of 15,940,383 cases were gathered in FAERS, 168,657 of which were related to DIT event cases. The top 50 drugs by case number and by signal strength were documented. The top five drugs by case number were lenalidomide (10601 cases), niraparib (3726 cases), ruxolitinib (3624 cases), eltrombopag (3483 cases) and heparin (3478 cases). The top five drugs by signal strength were danaparoid (ROR = 37.61, 95% CI 30.46‐46.45), eptifibatide (ROR = 34.75, 95% CI 30.65‐39.4), inotersen (ROR = 34.00, 95% CI 29.47‐39.23), niraparib (ROR = 30.53, 95% CI 29.42‐31.69) and heparin (ROR = 28.84, 95% CI 27.76‐29.97). The top 3 involved drug groups were Protein kinase inhibitors, Antimetabolites, and Monoclonal antibodies and antibody‐drug conjugates. The current comprehensive pharmacovigilance study identified more drugs associated with thrombocytopenia. While some drugs had been elucidated the mechanisms of DIT, others still required further investigation.This article is protected by copyright. All rights reserved

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

Cited by 2 publications

References 11 publications

Phenytoin-Induced Severe Thrombocytopenia: A Case Report

Phenytoin-Induced Severe Thrombocytopenia: A Case Report

An Updated Comprehensive Pharmacovigilance Study of Drug‐Induced Thrombocytopenia Based on FDA Adverse Event Reporting System Data

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