Phenytoin hypersensitivity presenting as postoperative fever

One of the most catastrophic complications of intracranial surgery is infection. These infections present frequently as postoperative fever and a change in sensorium. Phenytoin is used frequently in conjunction with intracranial operation to prevent seizures. We report two patients in whom, although the full phenytoin sensitivity syndrome ultimately developed, the presenting sign was postoperative fever. The phenytoin sensitivity syndrome is reviewed with emphasis on the fact that all components of the syndrome are not always present initially. The clinical significance of the presentation of phenytoin hypersensitivity as postoperative fever is discussed.