"Purple glove syndrome." Severe soft tissue reaction following phenytoin infusion

Deutsche medizinische Wochenschrift
A CadenbachM K Müller

Abstract

A 37-year-old woman, known since childhood to suffer from generalized seizures, was sent to the intensive care unit in status epilepticus. On admission tonic-clonic seizures persisted even after intravenously administration of clonazepam, 2 x 1 mg. She was unconscious and reacted unfocused to painful stimuli. Further seizures occurred with vomiting and respiratory failure threatened. After intubation phenytoin was given intravenously (initially 250 mg over 10 min, then 750 mg over 24 h) into a vein on the dorsum of the hand. The seizures stopped. Within a few hours a livid swelling developed at the site of the needle puncture on the right hand, which spread to the lower arm (purple glove syndrome) and the patients could no longer move her arm because of pain. The condition improved with anti-inflammatory treatment and antibiotics as well as local measures. On discharge she was able to make a first without pain. However, she was re-admitted 3 weeks later because of renewed painful impairment of right hand movement and the picture of early Sudeck's atrophy. Under regional anaesthesia complete mobility and freedom from pain was achieved within 2 weeks. Administration of phenytoin into a peripheral vein, especially of the hand, can...Continue Reading

Citations

Jul 3, 2015·Journal of Medical Toxicology : Official Journal of the American College of Medical Toxicology·Lyudmila A GarbovskyJeanmarie Perrone
Aug 10, 2006·Journal of Orthopaedic Science : Official Journal of the Japanese Orthopaedic Association·Motoki SonohataTakao Hotokebuchi
Dec 7, 2000·Journal of Child Neurology·H YoshikawaY Oda
Oct 3, 2001·Epilepsia·J G BurneoG L Barkley

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