Clinical features and risk factors of purple glove syndrome following intravenous administration of phenytoin in children: a case report in a Nigerian infant and review of literature

Enato IG, Akhimienho KI, Akhirevbulu ICG. Clinical features and risk factors of purple glove syndrome following intravenous administration of phenytoin in children: a case report in a Nigerian infant and review of literature. Case Study and Case Rep. 2021; 11(2): 18 - 27. ABSTRACT Several cases of purple glove syndrome (PGS) have been reported in adults and a few in children. However little or none is known about PGS in children in Africa, including Nigeria, as no known case has been reported in Nigerian children. We describe a case of PGS with compartment syndrome in a Nigerian infant; we also discuss the incidence, risk factors and complications of PGS in children. E.E is a one-year-old girl, who presented with features of severe malaria, shock and severe sepsis; and developed status epilepticus on admission. A single dose of Intravenous (IV) phenytoin was administered using a 24G cannula via one of the superficial veins on the dorsum of the left hand. Swelling of the left hand and bluish discolouration of the left thumb were noticed after 24 hours post IV phenytoin. A diagnosis of purple glove syndrome with compartment syndrome was made. Fasciotomy was performed on her hand; she recovered and was discharged after a prolonged hospital stay of two weeks. PGS can also occur in Nigerian children and it should be considered in all cases of skin discoloration and swelling at intravenous sites following administration of phenytoin. Underlying morbidities, such as severe sepsis, shock, metabolic acidosis, status epilepticus, may be major risk factors for PGS in children. Low index of suspicion by clinicians, unconsciousness and inability to localize pain may be additional risk factors in young children for development of complications such as compartment syndrome. Keywords: Purple Glove Syndrome, Phenytoin, Compartment Syndrome, Nigerian Infant. Keywords: Purple Glove Syndrome, Phenytoin, Compartment Syndrome, Nigerian, Infant