Sensory Deprivation or Postictal Vulnerability? Psychosis Following Phenytoin-Induced Toxic Epidermal Necrolysis – A Case Report
DOI:
https://doi.org/10.30834/KJP.38.2.2025.540Keywords:
Anti-seizure medications, Toxic Epidermal Necrolysis, Visual Impairment, Sensory Deprivation, PsychosisAbstract
Background: Acute cutaneous and mucosal manifestations of drug-induced toxic epidermal necrolysis are well recognized. Ocular complications lead to visual impairment and sensory deprivation and may predispose to psychosis.
Case Report: A 59-year-old woman with epilepsy, previously stable on anti-seizure medications, in whom phenytoin was introduced for breakthrough seizures. Following this, she developed toxic epidermal necrolysis (TEN), resulting in bilateral vision loss and subsequently full-blown psychosis. While she had shown mild irritability earlier, it was only after the seizure and abrupt sensory deprivation that she developed vivid hallucinations, delusions, and poor insight. The clear temporal sequence highlights the role of both postictal vulnerability and sensory deprivation in precipitating organic psychosis.
Conclusion: This case emphasizes the need to evaluate organic causes when elderly patients present with new-onset psychotic symptoms.
References
Mula M, Trimble MR, Sander JW. Are psychiatric adverse events of antiepileptic drugs a unique entity? A study on topiramate and levetiracetam. Epilepsia. 2007 Dec;48(12):2322-6. DOI: 10.1111/j.1528-1167.2007.01262.x
Creamer D, Walsh SA, Dziewulski P, Exton LS, Lee HY, Dart JK, et al. U.K. guidelines for the management of Stevens-Johnson syndrome/toxic epidermal necrolysis in adults 2016. Br J Dermatol. 2016 Jun;174(6):1194-227. DOI: 10.1111/bjd.14530
Sotozono C, Ueta M, Kinoshita S. Japan: Diagnosis and Management of Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis With Severe Ocular Complications. Front Med (Lausanne). 2021 Jul 28; 8:657327. DOI: 10.3389/fmed.2021.657327
Silverstein SM, Thompson JL. A vision science perspective on schizophrenia. Schizophr Res Cogn. 2015 Jun;2(2):39-41. DOI: 10.1016/j.scog.2015.05.003
Adachi N, Onuma T, Kato M, Sekimoto M, Okazaki M, Hara K, et al. Psychoses after an antiepileptic drug administration: Frequency, timing, and duration. Epilepsy Behav. 2023 Mar; 140:109087. DOI: 10.1016/j.yebeh.2023.109087
Morgan VA, Clark M, Crewe J, Valuri G, Mackey DA, Badcock JC, et al. Congenital blindness is protective for schizophrenia and other psychotic illness. A whole-population study. Schizophr Res. 2018 Dec; 202: 414-416.DOI: 10.1016/j.schres.2018.06.061
Pollak TA, Corlett PR. Blindness, Psychosis, and the Visual Construction of the World. Schizophr Bull. 2020 Dec 1;46(6):1418-1425. DOI: 10.1093/schbul/sbz098
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Copyright (c) 2025 Sthuthi Shireen, Aiswarya R Kamath, Bindu Menon (Author)
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