Intravenous Phenytoin-Induced Purple Glove Syndrome with Transient Hyperpigmentation: A Rare Adverse Drug Reaction in an Elderly Patient

Background: Purple Glove Syndrome (PGS) is an uncommon but potentially serious adverse effect of intravenous (IV) phenytoin, characterized by limb pain, swelling, and purple-blue discoloration near the injection site. Although self-limiting in most cases, it can progress to ischemia or necrosis. Case Presentation: A 68-year-old male with a prior cerebrovascular accident (CVA) and coronary artery disease (CAD) was admitted for seizure management. He received IV phenytoin 100 mg thrice daily. By the evening of Day 1, he developed pain, edema, and purplish discoloration at the right wrist, followed by hyperpigmentation on the left palm and right-hand nails. IV phenytoin was discontinued and managed conservatively with analgesics, topical emollients, and limb elevation. Outcome: The patient recovered completely within two weeks, with full restoration of hand function and fading of hyperpigmentation. Conclusion: This case emphasizes the need for early recognition of PGS, particularly in elderly patients, and highlights transient hyperpigmentation as a rare but reversible cutaneous manifestation.