Phenytoin Hypersensitivity Reaction: Hepatic necrosis

A 47-year-old black male treated with phenytoin for generalized seizures developed a generalized maculopapular rash approximately three weeks after starting therapy. In addition, fever, jaundice, diffuse lymphadenopathy, and elevated liver function enzymes resulted. A liver biopsy revealed hepatic necrosis. Treatment with oral prednisone 60 mg/d led to a resolution of the patient's clinical symptomatology and a normalization of his liver function enzymes in approximately two weeks. An updated review of the literature involving phenytoin-induced hepatic dysfunction is discussed, as well as both the postulated mechanisms causing the reaction, and therapeutic modalities of treatment.