Abstract
The significant dose-related as well as idiosyncratic drug toxicity are encountered in pediatric practice occasionally due to the zero order pharmacokinetics and narrow therapeutic margin of phenytoin. Among uncommon side effects reported in patients with phenytoin exposure are cerebellar atrophy and at times its clinical presentation is masquerading as acute encephalitis. An unusual presentation of phenytoin toxicity in a 15-year-old girl suffering from multiple tubercular with seizure who developed bilateral cerebellar atrophy besides other features of Phenytoin toxicity over 3 years of drug use has been reported here along with possible approaches to minimize the possibility of dosing error in its prescription. Keywords: Phenytoin, Cerebellar atrophy, Multiple tuberculoma
Highlights
Seizures are one of the commonest pediatrics emergencies and phenytoin is a commonly prescribed drug in such situation in India
In their case series in 1980, McLain et al[5] reported about five patients who were on phenytoin, had developed clinical signs of cerebellar dysfunction and showed diffuse cerebellar degeneration in CT scan
Some studies have pointed out that the role of drug duration is as important as are the drug levels in the causation of diffuse cerebellar atrophy
Summary
There are reports highlighting the association of longterm use of PHT and diffuse and reversible cerebellar atrophy. These changes have been reported only with the long-term use and at times even with normal drug levels.[2] Sensorium improved after 3 -4 days when the diagnosis of multiple tuberculoma with raised intra cranial tension was made and child was started on anti tubercular treatment (5 drugs, HRZES) along with prednisolone and pheytoin (100mg twice daily) besides Diamox and glycerol.
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