Clinicopathological and genotypic aspects of anticonvulsant-induced pseudolymphoma syndrome

Abstract

PLS may show histopathological findings similar to MF and take a prolonged course even after the cessation of causative agents. Thus, a clear understanding and diagnosis of this disease is considered to have an important effect on treatment and prognosis.

Selected Inflammatory Imitators of Mycosis Fungoides: Histologic Features and Utility of Ancillary Studies

“…42 Pseudolymphoma syndrome generally develops 2 to 8 weeks after initiation of the offending drug and is characterized by a typically widespread, maculopapular eruption; facial edema; fever; lymphadenopathy; arthralgia; peripheral eosinophilia; hepatosplenomegaly; and elevated liver enzymes. 41,42,47 Circulating, atypical lymphocytes may also be identified. 41,47 Notably, patients may not display all features typical of the syndrome.…”

“…41,47 Notably, patients may not display all features typical of the syndrome. 41,46,47 Drug-induced pseudolymphoma may be remarkably similar to MF with a dense, bandlike, lymphoid infiltrate in the superficial dermis; mild lymphocyte enlargement and atypia; and intraepidermal lymphocytes (Figure 4, C through H). 40,41,44 Pautrier microabscess-like structures have been reported.…”

“…Patients with anticonvulsant-induced pseudolymphoma may develop a characteristic pseudolymphoma syndrome, 40,41,43,44 which many experts include within the spectrum of hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms. 42,45,47,48 Uncommonly, this syndrome may occur with medications other than anticonvulsants.…”

“…Lesions are often associated with a new medication and resolve completely with discontinuation of the offending drug, although that may take several months. [40][41][42] The clinical presentation ranges from a diffuse, maculopapular eruption to papules, plaques, and/or nodules that may be solitary or multiple. [41][42][43][44][45][46] Rare cases of erythroderma have been reported (Figure 4, A and B).…”

“…[40][41][42] The clinical presentation ranges from a diffuse, maculopapular eruption to papules, plaques, and/or nodules that may be solitary or multiple. [41][42][43][44][45][46] Rare cases of erythroderma have been reported (Figure 4, A and B). 42,43,47 Medications that may cause drug-induced pseudolymphoma (DIP) are numerous and include antiepileptic drugs (eg, phenytoin, carbamazepine, sodium valproate), as well as other commonly prescribed medications, such as penicillin, b-blockers, angiotensin-converting enzyme inhibitors, and fluoxetine (as reviewed in Ploysangam et al 43 and Albrecht et al 48 ).…”