The occurrence of purple glove syndrome following the inadvertent oral administration of 1000 mg phenytoin/day is reported in a 10-year-old 18 kg handicapped boy who was admitted in coma to the Niigata City General Hospital, Japan. Within a few hours of the initial overdose, the boy was drowsy and he had nystagmus and vomiting. Several hours later, he developed dark purple discoloration and marked swelling of his hands and feet. After 4 days of the continued treatment, the boy became comatose, and his mother discontinued the drug. On admission, and 2 days after discontinuing treatment, the blood phenytoin level was 78 mcg/ml. The discoloration and swelling of the extremities gradually subsided and resolved completely after 11 days, without sequelae. [1]

COMMENT. Purple glove syndrome is a rare complication of intravenous administration of phenytoin. This appears to be the first report of the syndrome associated with oral phenytoin, administered in an overdose (55 mg/kg/d). Both hands and feet were affected in a glove and sock distribution. Recovery was complete without sequelae.