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Indian Pediatr 2014;51: 763-764

Purple Glove Syndrome Following Intravenous Phenytoin


Ashish M Shah and Arva Dahodwala

Department of Pediatrics,  Masina Hospital,  Mumbai, Maharashtra, India.
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Purple glove syndrome – characterized by purple discoloration and painful swelling of the hands like a glove – is an uncommon complication of intravenous phenytoin administration. A 1-day-old term asphyxiated neonate developed purple discoloration of hand 10 minutes after intravenous infusion of phenytoin, given for control of convulsions. The bluish purplish swelling of the hand extended up to elbow with ill-defined margin (Fig. 1). There was no tenderness, blistering, purulent discharge or mottling, Sensation and movements were normal. Oxygen saturation was 94% with low volume pulse and capillary refill time of 4-5 seconds. The color improved within 30-40 minutes of arm elevation and dry warm compresses. Complete recovery occurred in 72 hours.

Fig. 1 Purple discoloration with edema of right hand and forearm like a glove.

Differential diagnosis of purple glove syndrome includes cellulitis, necrotizing fasciitis and fluid extravasation. There was no discharge, bullous formation or tenderness, thereby ruling out cellulitis and necrotizing fasciitis. Intravenous fluid extravasation induces gradual edema with or without erythema.

 

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