Dilantin hypersensitivity syndrome

Dilantin Hypersensitivity Syndrome

Dilantin hypersensitivity syndrome is a rare but serious adverse reaction to the anticonvulsant medication Phenytoin, commonly known by the brand name Dilantin. This syndrome is characterized by a combination of symptoms that can include fever, rash, and internal organ involvement.

Symptoms

The symptoms of Dilantin hypersensitivity syndrome typically appear within 2 to 8 weeks after starting the medication. Common symptoms include:

• Fever
• Skin rash
• Lymphadenopathy
• Hepatitis
• Nephritis
• Eosinophilia

In severe cases, the syndrome can progress to involve multiple organ systems, leading to complications such as Stevens-Johnson syndrome or Toxic epidermal necrolysis.

Pathophysiology

The exact mechanism of Dilantin hypersensitivity syndrome is not fully understood, but it is believed to be an immune-mediated reaction. Genetic factors, such as certain HLA alleles, have been associated with an increased risk of developing this syndrome. The metabolism of phenytoin into reactive metabolites may also play a role in triggering the immune response.

Diagnosis

Diagnosis of Dilantin hypersensitivity syndrome is primarily clinical, based on the presentation of symptoms and the temporal relationship to phenytoin use. Laboratory tests may show elevated liver enzymes, eosinophilia, and other signs of systemic involvement. A skin biopsy may be performed to rule out other causes of rash.

Treatment

The primary treatment for Dilantin hypersensitivity syndrome is the immediate discontinuation of phenytoin. Supportive care, including the use of corticosteroids, may be necessary to manage symptoms. Patients should be monitored for complications and may require hospitalization in severe cases.

Prevention

Genetic testing for HLA alleles associated with hypersensitivity may be considered in certain populations before initiating phenytoin therapy. Alternative anticonvulsants should be used in patients with a known history of hypersensitivity to phenytoin.

Related pages

• Phenytoin
• Anticonvulsant hypersensitivity syndrome
• Stevens-Johnson syndrome
• Toxic epidermal necrolysis

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