Purple glove syndrome

Pavitra Manu Dogra¹ , Suman Kumar Pramanik² , Sebabrata Jana³

¹ Department of Nephrology and Renal Transplantation, Command Hospital (EC), Kolkata, West Bengal, India
² Department of Hematology, Command Hospital (EC), Kolkata, West Bengal, India
³ Department of Medicine, Command Hospital (EC), Kolkata, West Bengal, India

Correspondence Address:
Pavitra Manu Dogra
Department of Nephrology and Renal Transplantation, Command Hospital (EC), Alipore, Kolkata - 700 027, West Bengal
India

A 45-year-old woman who had previously undergone a kidney transplant was admitted with generalized tonic-clonic seizures. Two hours after she received an intravenous injection of phenytoin sodium, her right hand became painful, purple in color and edematous distal to the intravenous cannula site. We diagnosed purple glove syndrome following intravenous phenytoin sodium. She was managed with limb elevation, intravenous heparin and tramadol. Phenytoin was discontinued as there is anecdotal report of purple glove syndrome occurring even after oral ingestion of phenytoin. Hence she was started on oral levetiracetam. The purple hand gradually resolved with the subsidence of pain and edema and complete restoration of the original color of the right hand in 20 days. Though purple glove syndrome is due to irritation of tissues by local extravasations of crystallized phenytoin after injection, the reason for its occurrence after oral phenytoin ingestion is still a mystery, may be linked to the drug itself. It is advisable not to reuse phenytoin in such cases. [Figure - 1]

Figure 1: Purple discoloration of right hand distal to intravenous cannula site

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