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Phenytoin-Induced Severe Thrombocytopenia: A Case Report
Taweesak Maneerot1, Pirun Saelue2, Antida Sangiemchoey3
1Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Prince of Songkla University, Songkhla, THA.
Cureus
|June 20, 2024
Summary
Phenytoin, an antiepileptic drug, can rarely cause severe thrombocytopenia (low platelet count). Early recognition and discontinuation are crucial for patient recovery and preventing bleeding risks.
Area of Science:
- Neurology
- Hematology
- Pharmacology
Background:
- Phenytoin is a widely used antiepileptic medication for managing seizure disorders.
- Thrombocytopenia, a significant decrease in platelet count, is a rare but serious adverse effect associated with phenytoin therapy.
Observation:
- A case report details a 63-year-old male who developed severe thrombocytopenia (44 x 10^9/L platelets) seven days after initiating phenytoin for tonic-clonic seizures.
- The patient experienced no hemorrhage, and phenytoin was discontinued, with seizures subsequently managed by levetiracetam.
Findings:
- Discontinuation of phenytoin led to a significant improvement in platelet count, rising to 177 x 10^9/L within seven days.
- The Naranjo algorithm indicated a probable link between phenytoin and the induced thrombocytopenia, suggesting a drug-induced immune mechanism.
Implications:
- Phenytoin-induced thrombocytopenia, though rare, necessitates early detection due to the risk of life-threatening hemorrhage.
- Monitoring complete blood counts is essential in patients on phenytoin, especially those with bleeding risks or taking interacting medications that increase phenytoin epoxide levels.
