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Título

Dupuytren's contracture secondary to chronic use of phenobarbital: case report and literature review

RESUMO

Case report: Male, Caucasian, 65 years old, retired (rural area resident), attended the neurology outpatient clinic in October 2021 and showing pain and difficulty moving the fingers of both hands. He observed nodules and hardened tendons, with progressive installation in the last 3 years, with worsening in the last 6 months. He had epilepsy for 26 years: focal motor seizures with bilateralization, and focal impaired seizures, with epilepsy secondary to neurocysticercosis treated with praziquantel in the year 1996, with subsequent ischemic stroke in the year 2000, and status epilepticus, secondary to middle cerebral artery vasculitis due to active perivascular cysticercosis, treated with Prednisone. The patient evolved with control of epileptic seizures through the use of phenobarbital 200 mg/ day and carbamazepine 600 /day in the last 22 years. Examination of hands: palmar contracture, passive extension deficits of the 3 fingers (2º, 3º e 4º) with retraction and fibrosis of the flexor tendons and nodules. Abdominal ultrasound examinations were performed, in addition broad laboratory evaluation, and they were all normal, excluding secondary causes such as collagen diseases, and additional family’s history of Dupuytre's (CD) contracture, being defined a diagnosis of CD secondary to the use of phenobarbital.
Discussion: Dupuytren’s contracture (CD) is a fibroproliferative condition involving the superficial palmar fascia, leading to a progressive and irreversible flexion of the fingers. Dupuytren’s (CD) contracture might have a higher incidence in patients with epilepsy. In literature, there are different opinions regarding the phenobarbital, a common antiepileptic drug, and its effective role in the genesis and development of CD. We believe that phenobarbital causes a dose and time-dipendent profibrotic effect. The CD’s aetiology of some aspects is still unclear. Many factors are already known to be implicated, and there are different opinions regarding the association with the phenobarbital used for the antiepileptic treatment, and its effective role in the genesis and development of Dupuytren’s contracture.
Final comments: Our case report demonstrate that phenobarbital cause a dose and time-dipendent profibrotic effect and must to be involved in the genesis of Dupuytren’s contracture. Progressive withdrawal of phenobarbital and introduction of Valproate was performed, and he was referred for surgical treatment by an orthopedist.

Palavras Chave

Dupuytren's contracture, phenobarbital.