A prospective study of the incidence of the purple glove syndrome

Purpose: Phenytoin (PHT) has been widely used intravenously for the treatme nt of seizures since 1956, and for many years, it has been considered first -line therapy for status epilepticus. It is routinely administered intraven ously in emergency departments and hospitals for patients who have had isol ated seizures and for many patients undergoing neurosurgical procedures who are unable to receive oral medication. Adverse reactions from PHT have bee n widely studied for years, but in the past decade, new adverse reactions h ave been identified. One of these adverse reactions is the purple glove syn drome (PGS), characterized by edema, discoloration, and pain distal to the site of i.v. administration of PHT. Because there have been no prospective reports of the incidence of PGS, the objective of the study was to report t he incidence of this syndrome. Methods: We enrolled 179 consecutive exposures to i.v. PHT at Henry Ford Ho spital. Distal portions of the upper extremities were examined and digitall y photographed by one of the authors (J.G.B.). The photos were blindly eval uated by the third author (G.L.B.) for PGS. Demographic and pertinent medic al history was recorded for all patients, and outcome for those who experie nced PGS was recorded. Associations between PGS, demographic, and medical h istory information were assessed. Results: In only three of the 179 exposures did PGS develop. In both patien ts, the severity of the clinical picture was mild and did not required prol onged hospitalization or specialized treatment. Conclusions: PGS is an infrequent and mild adverse effect of i.v. PHT admin istration.