[e-farmacos] Sindrome de hipesensibilidad a hidantoinas (cont.)

["Zambon, Fabio" <fgzambon@yahoo.com.ar>]

Yo no soy Pediatra, y quiza lo que digo no tenga mucho valor, pero en general el sme. de hipersensibilidad a DFH se caracteriza por rash, fiebre, linfadenopatias, leucocitosis con linfocitos atipicos, eosinofilia y hepatitis. El caso que describes, cuya edad no conocemos, me recordo al "gasping sme." de los neonatos:

Dilantin(R) 30 mg capsule and oral suspension contain sodium benzoate; benzoic acid (benzoate) is a metabolite of benzyl alcohol; large amounts of benzyl alcohol (99 mg/kg/day) have been associated with a potentially fatal toxicity ("gasping syndrome") in neonates; the "gasping syndrome" consists of metabolic acidosis, respiratory distress, gasping respirations, CNS dysfunction (including convulsions, intracranial hemorrhage), hypotension and cardiovascular collapse; use phenytoin products containing sodium benzoate with caution in neonates; in vitro and animal studies have shown that benzoate displaces bilirubin from protein binding sites. Injection contains 40% propylene glycol and 10% alcohol.

De todas maneras, esto es lo que dice el Mandell sobre el tema:

Dilantin Hypersensitivity Syndrome
The Dilantin (phenytoin) hypersensitivity syndrome is commonly confused with a variety of systemic infections, and the correct diagnosis is often realized only after exhaustive microbiologic cultures have proved negative and empirical antibiotics have been used without success. Patients with this unique hypersensitivity reaction typically manifest sudden fever, with temperatures often as high as 104°F (40°C), and a clinical appearance of toxicity, followed by the development of rash, generalized lymphadenopathy, and leukocytosis (sometimes with mild eosinophilia). In more protracted cases, hepatosplenomegaly may occur in association with elevated transaminase levels. Without treatment, small numbers of patients eventually die of either hepatic necrosis or renal failure.

This heterogeneous eruption is remarkably distinctive, allowing for its diagnosis at the bedside. The face is edematous and red. Lips may be similarly swollen and red. Confluent erythema is present on the central trunk, with a paucity of tiny sterile pustules studding the surface of the flanks. A more morbilliform maculopapular eruption is present acrally, and the palms and soles are also involved. In contrast to most drug eruptions, the Dilantin hypersensitivity syndrome typically occurs months or later into treatment with the drug and will recur if the patient receives any of several other anticonvulsants (most notably phenobarbital and carbamazepine [Tegretol]). Treatment involves discontinuation of the offending drug and administration of high-dose systemic corticosteroids; major flares can be expected if a very slow taper over several months is not used.

Si te interesa una lista completa de interacciones farmacologicas de la DFH, pidemela que te la reenvio.

Suerte,

Dr. Fabio Zambon
Buenos Aires
(Argentina)