Massive hepatic necrosis in a child after administration of phenobarbital

A 2-yr-old child developed massive hepatic necrosis caused by an unusual hypersensitivity response to phenobarbital that was prescribed for presumed febrile seizures. Despite discontinuation of the barbiturate, this child experienced fulminant hepatic failure and died. Review of the literature indicates that phenobarbital-induced hepatic injury is uncommon and usually mild. Prompt and permanent cessation of the drug results in resolution of symptoms in most patients.