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Early-onset phenytoin toxicity mimicking a renopulmonary syndrome
A J Polman1, T S van der Werf, A T Tiebosch
1Dept of Internal Medicine, University Hospital Groningen, The Netherlands.
Abstract:
Phenytoin is a commonly used anti-epileptic drug. Adverse reactions including fever, skin reactions and lymphadenopathy are well known but atypical reactions can also occur. A patient is described with a lag time of only 4 days between onset of phenytoin and the development of a syndrome with acute lung injury and renal failure. The symptoms mimicked a renopulmonary syndrome, and resolved completely after cessation of phenytoin and addition of steroids.
Insights
Phenytoin can cause rare but severe lung and kidney injury. This case highlights a rapid-onset renopulmonary syndrome linked to the anti-epileptic drug, resolving with steroid treatment.
Area of Science:
- Pharmacology
- Nephrology
- Pulmonology
Background:
- Phenytoin is a widely prescribed anti-epileptic medication.
- Known adverse reactions include fever, skin issues, and lymphadenopathy.
- Atypical drug reactions can manifest with severe organ involvement.
Observation:
- A patient developed acute lung injury and renal failure shortly after starting phenytoin.
- The clinical presentation mimicked a renopulmonary syndrome.
- Symptoms appeared rapidly, with a 4-day lag time from phenytoin initiation.
Findings:
- Cessation of phenytoin led to symptom resolution.
- The addition of corticosteroid therapy facilitated complete recovery.
- This suggests a hypersensitivity reaction to phenytoin.
Implications:
- Highlights the potential for phenytoin-induced acute lung injury and renal failure.
- Emphasizes the importance of considering drug-induced syndromes in renopulmonary presentations.
- Suggests prompt withdrawal of the offending agent and corticosteroid use for management.