Purple glove syndrome

Background

  • Uncommon skin complication of phenytoin
  • Typically associated with IV infiltration of phenytoin, but poorly understood pathophysiology
  • Proposed mechanisms include:[1]
    • Chemical irritation from added propylene glycol and sodium hydroxide
    • Vasoconstriction
    • Vasculitis
    • Microthrombus formation
    • Phenytoin leakage into soft tissue with subsequent edema
  • Generally develops within first 24 hours after infusion, resolves within days to weeks [2]
Purple glove syndrome.png

Clinical Features

  • Peripheral edema, blistering, pain, and discoloration of the extremity receiving intravenous phenytoin
  • Pulses and sensation may be diminished
  • Skin necrosis may develop

Differential Diagnosis

Skin and Soft Tissue Infection

Look-A-Likes

Evaluation

  • Clinical diagnosis based on history and exam

Management

  • Optimal management remains unclear
  • Some case reports found improvement with
    • topical [[nitroglycerin[[
    • brachial plexus nerve block
    • elevation, heat application, soft tissue massage
  • Consider vascular or hand consult if digital or skin necrosis suspected
    • Anticoagulation is occasionally started (no clear evidence that it is effective) [3]

Disposition

  • Given possibility of severe outcomes, recommend 24 hours of observation in asymptomatic patients

See Also

External Links

References

  1. Bhattacharjee P.. Early histopathologic changes in purple glove syndrome. J Cutan Pathol. 2004;31(7):513-5.
  2. Santoshi JA. Purple glove syndrome: a case report. Hand surgeons and physicians be aware. J Plast Reconstr Aesthet Surg. 2010;63(3):e340-2.
  3. Scumpia AJ. Purple glove syndrome after intravenous phenytoin administration presenting in the emergency department. J Emerg Med. 2013;44(2):e281-3.