Phenytoin/sodium-valproate

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Phenytoin/sodium-valproate Stevens Johnson syndrome: case report

A 46-year-old woman developed Stevens Johnson syndrome (SJS) during anti-epileptic therapy with sodium valproate and phenytoin [routes and dosages not stated]. The woman presented with complaints of urinary incontinence, vomiting, abnormal body movements, mild fever and chills. She had a history of hypertension, for which, she had been receiving amlodipine. Following investigations, a diagnosis of meningoencephalitis with pulmonary thromboembolism was made and further treatment was started with anti-epileptics including injections of sodium valproate and phenytoin along with levetiracetam, clobazam, anti-emetics, anti-coagulants and antibiotics at the ICU. After 17 days of hospitalisation, she was discharged home with sodium valproate tablet, phenytoin tablet and clobazam. However, after 26 days of starting sodium valproate and phenytoin, she developed generalise body rash for which she presented to hospital (after 11 days of discharge). Her erythematous rash progressed to trunks followed by face, lips and upper limbs. She also developed facial puffiness, difficulty in swallowing and mild discomfort in breathing. Examination showed erosions over the lips and oral mucosa that restricted her mouth opening. On the back and limbs, erythematous, maculopapular dark coloured rashes were present. Thus, a diagnosis of SJS secondary to sodium valproate and phenytoin was made. Her SCORTEN score was 2. The woman’s sodium valproate and phenytoin were withdrawn, but clobazam was continued. She was treated with hydrocortisone and anti-histamines and her symptoms subsided gradually. Nakarmi P, et al. Dual antiepileptics induced stevens-johnson syndrome: A case report. JNMA 58: 801-804, No. 230, 15 Oct 2020. Available from: URL: http:// doi.org/10.31729/jnma.5308

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Reactions 14 Nov 2020 No. 1830

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