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Acute phenytoin intoxication in a 4-year-old mimicking viral meningoencephalitis

Amlin Shukla1, Jhuma Sankar, Ankit Verma

  • 1Department of Pediatrics, PGIMER, Dr RML Hospital, New Delhi, India.

BMJ Case Reports
|July 2, 2013
PubMed

Insights

A child presented with seizures and neurological symptoms, initially suspected as viral meningoencephalitis. Diagnosis shifted to acute phenytoin toxicity after elevated serum levels confirmed accidental overdose, highlighting a rare intoxication presentation.

Area of Science:

  • Pediatric Neurology
  • Clinical Toxicology

Background:

  • Acute phenytoin toxicity is a rare condition that can mimic central nervous system infections.
  • Children may present with non-specific neurological symptoms, complicating diagnosis.

Observation:

  • A 4-year-old female presented with generalized tonic-clonic convulsions, vomiting, irritability, and dysarthria.
  • Initial examination revealed decreased responsiveness, neck stiffness, and bilateral extensor plantars, suggestive of meningoencephalitis.
  • Further history revealed an elder sibling was prescribed phenytoin, prompting suspicion of toxicity.

Findings:

  • Serum phenytoin levels were significantly elevated at 80 μgm/mL (normal: 10-20 μgm/mL).
  • The child's symptoms resolved with conservative management.
  • The patient was discharged after 5 days of hospitalization.

Implications:

  • This case underscores the importance of considering drug toxicity in pediatric patients with neurological symptoms.
  • Accurate history taking, including family medication use, is crucial for diagnosing rare intoxications.
  • Early recognition and management of phenytoin toxicity can prevent severe neurological complications.

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