Phenytoin induced Stevens Johnson syndrome: a case report

Stevens-Johnson syndrome (SJS) is a rare consequence of hypersensitivity reaction precipitated by certain drugs and viral infections. It is an idiosyncratic drug reaction usually associated with drugs like anti-epileptics, non-steroidal anti-inflammatory compounds and antibiotics. The overall incidence of this entity is very low and is life-threatening if undiagnosed and untreated. The syndrome is characterized by purpuric macules and bullous eruptions involving the mucous membrane which may be followed by systemic manifestations. The mechanism of SJS due to drugs is not fully defined. Delayed Hypersensitivity reaction mediated by T lymphocytes in response to a drug is thought to be responsible. Here authors present a case of SJS induced by phenytoin in an adult male. The case warrants the need of adopting a meticulous approach while prescribing phenytoin. The case is being reported to accentuate the importance of adverse drug reactions and to emphasize the importance of reporting such reactions ensuring efficient pharmacovigilance.

REPORTS FROM THE UNIVERSITY HEALTHSYSTEM CONSORTIUM

Heparin-induced thrombocytopenia (HIT) is an idiosyncratic drug reaction first reported in the literature in the 1940's. Two different types of HIT have been identified. Type I, also known as benign, early-onset thrombocytopenia, occurs in as many as 20% of patients receiving heparin and is characterized by up to a 30% reduction in baseline platelet counts during the first few days of therapy. Despite reductions in platelet count, most patients with this type of HIT have platelet values above 100 × 109 cells/L, and this condition usually resolves in a few days without further adverse sequelae.

Cholestasis in Crohn's Disease: A Diagnostic Challenge

A 24-year-old male with Crohn's disease who developed three independent episodes of cholestatic liver disease over an eight-year period is described. The first episode was related to an idiosyncratic drug reaction while on sulfasalazine. The second episode, at the time of an exacerbation of his colitis, was characterized by moderate portal inflammation on liver biopsy and resolved quickly while he was on corticosteroid therapy. The most recent episode, occurring when the bowel disease was quiescent, was due to granulomatous hepatitis and resolved clinically with no specific therapy. Because numerous potentially serious hepatobiliary complications have been associated with inflammatory bowel disease, prompt and aggressive investigation in these instances is recommended.