Case Challenge #2 presented a 42 yo female with fever, LAD, macular rash, and elevated LFTs after the recent intiation of phenytoin for new onset seizures.
What is the best management step?
D) Stop phenytoin – the patient has Anticonvulsant Hypersensitivity Syndrome
- Starts within 2-4 weeks of starting anti-epileptics with aromatic benzene rings (subset of DRESS)
- Main culprits: Carbamazepine, Phenytoin, Primidone, Phenobarbital
- Stop drug and avoid repeat exposure to similar drugs
- Buzz words: Rash, LAD, hepatitis, renal failure in person on offending agent
- Eosinophilia only seen in about 20% of cases
Look forward to a more extensive review of Anticonvulsant Hypersensitivity Syndrome. There will be a new case challenge next week!