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Phenytoin Induced Purple Glove Syndrome: An Effective Management Technique

Mutsago, Tonderai; Kazzazi, Danny; Ibrahim, Yahya; Kazzazi, Fawz; Patel, Hasu; Pafitanis, Georgios; (2024) Phenytoin Induced Purple Glove Syndrome: An Effective Management Technique. Hospital Pharmacy , 59 (3) pp. 276-281. 10.1177/00185787231224064. Green open access

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Abstract

Background: Purple glove syndrome (PGS) is a rare condition characterized by limb edema, discoloration, and pain associated with intravenous and oral phenytoin administration. The pathophysiology is poorly understood, and there is no established treatment. Simple cases have previously been managed with hyaluronidase subcutaneous injections, with more severe cases resulting in compartment syndrome, debridement, or even amputation. Methods/Results: In this case report, a 2-year-old boy with status epilepticus developed PGS after receiving intravenous phenytoin via a cannula on the dorsum of the right hand. The patient was successfully managed by locally infiltrating subcutaneous hyaluronidase diffusely to the affected area, titrating its dose to effect, rather than aiming to adhere to any specific dosing limitation. The child was reviewed daily by the Plastic Surgery team until being discharged, and focal lesions began to demarcate after 48 hours, with epidermal loss but no deeper trauma. The epidermis peeled within one month, with healthy underlying skin found underlying when followed up in clinic. Conclusions: This case illustrates that subcutaneous administration of hyaluronidase and titrating to effect provides an effective and safe treatment for treating distal cases of early PGS in children.

Type: Article
Title: Phenytoin Induced Purple Glove Syndrome: An Effective Management Technique
Location: United States
Open access status: An open access version is available from UCL Discovery
DOI: 10.1177/00185787231224064
Publisher version: https://doi.org/10.1177/00185787231224064
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: EXTRAVASATION, hyaluronidase, HYALURONIDASE, Life Sciences & Biomedicine, Pharmacology & Pharmacy, phenytoin, purple glove syndrome, Science & Technology
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > UCL Medical School
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > UCL Medical School > Clinical and Professional Practice Unit
URI: https://discovery-pp.ucl.ac.uk/id/eprint/10203519
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