Perez Del Nogal Genesis, Rodaniche Alyssa, Saragadam Sailaja Devi
Internal Medicine, Texas Tech University Health Sciences Center, Odessa, USA.
Laboratory Science and Primary Care, Texas Tech University Health Sciences Center, Odessa, USA.
Cureus. 2022 Apr 8;14(4):e23958. doi: 10.7759/cureus.23958. eCollection 2022 Apr.
An uncommon but serious adverse drug reaction after phenytoin administration is known as purple glove syndrome (PGS). Initial presentation is characterized by pain, skin discoloration, and edema, that can progress to necrosis. The pathophysiology remains uncertain; however, multiple mechanisms have been reported including extravasation. We describe a case of a 61-year-old patient who was brought to the hospital with altered mental status due to status epilepticus. The patient received multiple doses of lorazepam; eventually was started on levetiracetam and valproate, including loading doses. The seizures were poorly controlled despite treatment, and intravenous (IV) phenytoin was added. The next day, bluish discoloration and swelling to bilateral upper distal extremities were noted on physical examination. Consequently, IV phenytoin was discontinued immediately due to high suspicion of PGS. Skin discoloration and edema gradually improved after one week, confirming a case of mild PGS.
苯妥英钠给药后一种罕见但严重的药物不良反应被称为紫手套综合征（PGS）。初始表现的特征是疼痛、皮肤变色和水肿，可进展为坏死。其病理生理学仍不确定；然而，已报道多种机制，包括外渗。我们描述了一例61岁的患者，因癫痫持续状态导致精神状态改变而被送往医院。该患者接受了多次剂量的劳拉西泮；最终开始使用左乙拉西坦和丙戊酸盐，包括负荷剂量。尽管进行了治疗，癫痫发作仍控制不佳，遂加用静脉注射苯妥英钠。第二天，体格检查发现双侧上肢远端出现蓝色变色和肿胀。因此，由于高度怀疑PGS，立即停用了静脉注射苯妥英钠。一周后皮肤变色和水肿逐渐改善，确诊为轻度PGS病例。
