Purple glove syndrome caused by oral administration of phenytoin

Area of Science:

• Pharmacology
• Neurology
• Toxicology

Background:

• Phenytoin is an anticonvulsant medication commonly used to control seizures.
• Accurate dosing is crucial for patient safety and treatment efficacy.
• Purple glove syndrome (PGS) is a rare but serious adverse reaction typically associated with intravenous phenytoin administration.

Observation:

• A 10-year-old boy with a history of seizures, well-controlled with phenytoin, accidentally received a 10-fold overdose (1000 mg instead of 100 mg daily).
• Within hours of the overdose, the patient exhibited drowsiness, marked swelling, and dark purple discoloration of his hands and feet.
• These symptoms persisted for four days before the medication was discontinued.

Findings:

• The patient developed symptoms consistent with purple glove syndrome following oral administration of a high dose of phenytoin.
• Following discontinuation of phenytoin and initiation of fluid therapy, the swelling and discoloration gradually resolved over 11 days.
• This case represents a potential first report of purple glove syndrome linked to the oral administration of an excessive phenytoin dose.

Implications:

• This case highlights the potential for severe adverse reactions, including purple glove syndrome, even with oral phenytoin administration when overdosed.
• It underscores the importance of meticulous medication management and patient monitoring to prevent accidental overdoses and associated toxicities.
• Further investigation may be warranted to understand the mechanisms underlying oral phenytoin-induced purple glove syndrome.