Purple Glove Syndrome Is Not Always Purple at the Initial Presentation : A Case Report and Literature Review

Abstract

Background: Purple glove syndrome (PGS) is a rare complication of intravenous phenytoin use that typically presents with pain, edema, and discoloration at the injection site that spreads to the distal limb. Case Presentation: A 25-year-old female patient presented to Kind Fahad University hospital’s emergency department (ER) following a seizure episode, on admission to the hospital she was found to have profound tonic-clonic seizures, flexed limbs, uprolling eyes and frothy secretion from her mouth. The patient received IV fluid 0.9 NS and diazepam 5 mg IV injection followed by Phenytoin 1g was IV administrated on 100cc NS over 3 hours with a dose of 50 mg IV/min, and was admitted to the medicine service. Soon, the patient felt pain, swelling, Erythema and abnormal movement from the site of the IV cannula over the left forearm while Phenytoin was being injected, however no purple discoloration was detected and the patient was diagnosed with purple Glove syndrome (PGS). Accordingly, Phenytoin was held and replaced by carbamazepine for Seizure control, Brain MRI and EEG were ordered simultaneously. Patient symptoms were alleviated 2 days later and was ready for discharge. Follow-up visits were scheduled until the patient was fully recovered and aware of the implications of Phenytoin on her case. Conclusion: Since PGS is a rare complication of IV phenytoin therapy, it’s not common to link the clinical symptoms of PGS to Phenytoin adverse reactions at the first prognosis especially when discoloration - which is a profound symptom of PGS -is missing. The risk of PGS for this patient may have been abated at the very early stage by decreasing the phenytoin infusion rate from 50 mg/min to less than 25 mg/min.