Bhattacharjee Pradip, Glusac Earl J
Departments of Pathology and Dermatology, Yale University School of Medicine, New Haven, CT 06520, USA.
J Cutan Pathol. 2004 Aug;31(7):513-5. doi: 10.1111/j.0303-6987.2004.00224.x.
An 86-year-old African-American man presented with tonic-clonic seizures. Intravenous phenytoin was urgently administered into the dorsum of the right hand. The patient developed a raised purple area of discoloration around the intravenous insertion site within 2 h and edema and vesiculobullous lesions of the distal forearm, hands, and fingers within 8 h. Microscopic sections from a biopsy at 12 h revealed epidermal necrosis, superficial ulceration, and a mild superficial and deep perivascular lymphoid infiltrate, associated with numerous thrombi of small vessels throughout the dermis. The findings were judged to be consistent with soft-tissue injury associated with intravenous administration of phenytoin, also termed purple glove syndrome. Purple glove syndrome, named for its distinctive purple discoloration and swelling of the hands in the distribution of a glove, is an uncommon complication of intravenous phenytoin administration through small dorsal veins of the hands. It is comprised by pain, discoloration, and edema in the vicinity of intravenous infusion of phenytoin through dorsal veins of the hand. The histopathologic features of fully developed lesions have been reported; however, early-stage findings have not been previously described, and the histogenesis of this lesion is controversial. The presence of thrombi in this early-stage lesion suggests that thrombosis plays a role in the initial pathogenesis of this condition.
一名86岁的非裔美国男性出现强直阵挛性癫痫发作。紧急将静脉注射苯妥英钠注入右手背。患者在2小时内静脉穿刺部位周围出现紫色隆起的变色区域，8小时内前臂远端、手部和手指出现水肿和水疱性病变。12小时活检的显微镜切片显示表皮坏死、浅表溃疡，以及轻度的浅表和深部血管周围淋巴细胞浸润，真皮内可见多处小血管血栓形成。这些发现被判定与静脉注射苯妥英钠相关的软组织损伤一致，也称为紫手套综合征。紫手套综合征因其手部独特的紫色变色和手套分布区域的肿胀而得名，是通过手部背侧小静脉静脉注射苯妥英钠的一种罕见并发症。它表现为通过手部背侧静脉静脉注射苯妥英钠附近区域的疼痛、变色和水肿。已报道了完全发展病变的组织病理学特征；然而，早期发现此前尚未描述，且该病变的组织发生存在争议。此早期病变中血栓的存在表明血栓形成在该病症的初始发病机制中起作用。
