A 47-year-old black male treated with phenytoin for generalized seizures developed a generalized maculopapular rash approximately three weeks after starting therapy. In addition, fever, jaundice, diffuse lymphadenopathy, and elevated liver function enzymes resulted. A liver biopsy revealed hepatic necrosis. Treatment with oral prednisone 60 mg/d led to a resolution of the patient's clinical symptomatology and a normalization of his liver function enzymes in approximately two weeks. An updated review of the literature involving phenytoin-induced hepatic dysfunction is discussed, as well as both the postulated mechanisms causing the reaction, and therapeutic modalities of treatment.
MichaelJRMitchWE.Reversible renal failure and myositis caused by phenytoin hypersensitivity. JAMA1976: 236: 2773–5.
5.
HuijgensPCThijsLGOttolanderGJD.Pure red cell aplasia, toxic dermatitis and lymphadenopathy in a patient taking diphenylhydantoin. Acta Haematol1978; 59: 31–6.
CohenBLBovassoGJ.Leukopenia as an unusual component of diphenylhydantoin hypersensitivity. Clin Pediatr1973; 12: 622–3.
8.
ZidarBLMendelowHWinkelsteinADiphenylhydantoin-induced serum sickness with fibrin-platelet thrombin in lymph node microvasculature. Am J Med1975; 58: 704–8.
9.
KlecknerHBYakulisVHellerP.Severe hypersensitivity to diphenylhydantoin with circulating antibodies to the drug. Ann Intern Med1975; 83: 522–3.
10.
GitlinNMorrisHB.Flapping tremor associated with administration of diphenylhydantoin sodium. S Afr Med J1976; 23: 1427.
11.
LeeTJCarneyCNLapisJLDiphenylhydantoin-induced hepatic necrosis — a case study. Gastroenterology1976; 70: 422–4.
12.
CampbellCBMcGuffieCWeedonAPCholestatic liver disease associated with diphenylhydantoin therapy — possible pathogenic importance of altered bile salt metabolism. Am J Dig Dis1977; 22: 255–62.
13.
AhmadI.A case of isolated increase in serum alkaline phosphatase activity. Clin Chem1978; 24: 1850–1.
