Shravan V
Jawaharlal Institute of Postgraduate Medical Education and Research, India
Title: Lyell’s syndrome induced by phenytoin complicated by road traffic accident
Biography
Biography: Shravan V
Abstract
Introduction: Even after approval of the drug and coming to the market, there are many tragedies reported due to drug resulting in withdrawal of drug from the market for that particular indication. Eg: Thalidomide tragedy. In order to monitor this, there should be vigilant people who should identify the adverse reaction of the drug and to report in an expedited way to the authorities concerned.
Case: An 18 year old patient had a history of Road Traffic Accident (RTA) followed by seizures. He was admitted in the hospital and prescribed Inj. Phenytoin 900 mg IV stat followed by Tab. Phenytoin 100 mg. Following the oral administration, patient developed fever and bullous lesions all over the body with oropharyngeal ulcer and eye infection. On examination, patient was found to have multiple vesicles over chest, abdomen, bilateral upper extremities, crusted erosion over lips and conjuctival congestion. Patient was stopped T. Phenytoin in suspect of phenytoin induced Lyell’s syndrome. Patient was treated with pulse therapy of Dexamethasone (80 ml in 250 ml of 5% dextrose), Azithromycin, Paracetamol infusion, Tobramycin eye drops and ointment. For the seizure complaint, the patient was started on Inj. Levetiracetam infusion.
Conclusion: Phenytoin should be stopped at the onset of development of rash and genetic cause (HLA-B*1502 and HLA-A*3101) should also be borne in mind as the susceptibility increases with genetic etiology. Preventive measures should be educated to the patient as RTA also increases the risk of seizures.