Idiosyncratic Reactions to Phenytoin

We present a detailed case report of an idiosyncratic reaction to phenytoin and review the manifestations in 16 additional pediatric patients (2.5-21 years of age) described in the literature. These cases illustrate the frequency of fever (82%), rash (94%), lymphadenopathy (94%), hepatitis (94%), and eosinophilia (76%). This constellation of signs and symptoms will frequently mimic common pediatric illnesses so the pediatrician responsible for the care of the seizure patient being treated with phenotoin should be aware of the possibility of an idiosyncratic reaction. Delay in discontinuation of the drug may be life-threatening.

[1]  S. Bank,et al.  Diphenylhydantoin-induced hepatotoxicity. , 1985, The American journal of gastroenterology.

[2]  H. Krous,et al.  Diphenylhydantoin-induced hypersensitivity reaction with interstitial nephritis. , 1985, Human pathology.

[3]  G. Faguet,et al.  Drug-induced liver injury. In vitro demonstration of hypersensitivity to both phenytoin and phenobarbital. , 1984, Archives of internal medicine.

[4]  R. Simon,et al.  The incidence of ingested metabisulfite sensitivity in an asthmatic population , 1982 .

[5]  G. Gordon,et al.  Predisposition to phenytoin hepatotoxicity assessed in vitro. , 1981, The New England journal of medicine.

[6]  S. Rothman,et al.  Phenytoin hypersensitivity. , 1980, The Journal of allergy and clinical immunology.

[7]  F. Haruda.  Phenytoin hypersensitivity , 1979, Neurology.

[8]  M. Pollack,et al.  Mucocutaneous eruptions due to antiepileptic drug therapy in children , 1979, Annals of neurology.

[9]  H. Fallon,et al.  Diphenylhydantoin-induced hepatic necrosis. A case study. , 1976, Gastroenterology.

[10]  A. Weedon.  Diphenylhydantoin sensitivity. a syndrome resembling infectious mononucleosis with a morbilliform rash and cholestatic hepatitis. , 1975, Australian and New Zealand journal of medicine.

[11]  P. Heller,et al.  Letter: Severe hypersensitivity to diphenylhydantoin with circulating antibodies to the drug. , 1975, Annals of internal medicine.

[12]  C. Pierach,et al.  Diphenylhydantoin--induced hepatic necrosis. , 1974, Postgraduate medicine.

[13]  T. Sorrell,et al.  Depression of immunological function in patients treated with phenytoin sodium (sodium diphenylhydantoin). , 1971, Lancet.

[14]  L. Ch'ien,et al.  Diphenylhydantoin fatal hepatic necrosis (a review of literature and report of a case treated with exchange transfusion). , 1970, The Alabama journal of medical sciences.

[15]  P. R. Scaglione,et al.  Pseudolymphoma induced by diphenylhydantoin. , 1970, The Journal of pediatrics.

[16]  J. Pezzimenti,et al.  Anicteric hepatitis induced by diphenylhydantoin. , 1970, Archives of internal medicine.

[17]  R. Gams,et al.  Hydantoin-induced pseudo-pseudolymphoma. , 1968, Annals of internal medicine.

[18]  I. Braverman,et al.  DILANTIN-INDUCED SERUM SICKNESS. CASE REPORT AND INQUIRY INTO ITS MECHANISM. , 1963, The American journal of medicine.

[19]  S. E. Crawford,et al.  Fatal liver necrosis and diphenylhydantoin sensitivity. , 1962, Pediatrics.

[20]  M. Bajoghli.  Generalized lymphadenopathy and hepatosplenomegaly induced by diphenylhydantoin. , 1961, Pediatrics.

[21]  L. Ackerman,et al.  Lymphadenopathy induced by anticonvulsant drugs and mimicking clinically and pathologically malignant lymphomas , 1959, Cancer.

[22]  J. Gaddum.  THE PHARMACOLOGICAL BASIS OF THERAPEUTICS , 1941, Nature.