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Phenytoin hepatotoxicity masked by corticosteroids
M Lisker-Melman1, J H Hoofnagle
1Digestive Disease Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD 20892.
Archives of Internal Medicine
|May 1, 1989
Summary
Phenytoin can cause liver damage, especially when corticosteroids mask its symptoms. This case highlights the risk of delayed diagnosis for phenytoin-induced hepatotoxicity in patients on both medications.
Area of Science:
- Hepatology
- Clinical Pharmacology
- Neurology
Background:
- Phenytoin is a widely used anticonvulsant medication.
- Liver toxicity is a known adverse effect of phenytoin.
- Corticosteroids are often used to manage cerebral edema following neurosurgery.
Observation:
- A patient undergoing transsphenoidal pituitary tumor resection developed phenytoin-induced hepatotoxicity.
- The symptoms of liver toxicity were masked by concurrent corticosteroid therapy for cerebral edema.
- Systemic signs of phenytoin hypersensitivity were not recognized due to corticosteroid administration.
Findings:
- Phenytoin-induced hepatotoxicity can be obscured by corticosteroid treatment.
- Delayed recognition of phenytoin hypersensitivity can occur in patients receiving both drugs.
- This masking effect can lead to a potentially lethal complication of phenytoin therapy.
Implications:
- Clinicians must maintain a high index of suspicion for phenytoin-induced liver toxicity in patients receiving corticosteroids.
- Careful monitoring for liver function is crucial in patients on combined phenytoin and corticosteroid therapy.
- This case underscores the importance of recognizing drug interactions and atypical presentations of adverse drug reactions.