Answer to Case Challenge #2

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!