Myelomatosis after Phenytoin Therapy A Chance Association?

Abstract

The occurrence of a monoclonal gammopathy followed by IgG‐lambda multiple myeloma is described in a patient receiving diphenylhydantoin therapy for 20 years for epilepsy. Despite the known association between the drug and the development of immunosuppression and lymphoma, we regard the association recorded in this case to be coincidence. It is suggested that periodic examination of the serum proteins in patients receiving the drug may be useful in detecting early aberrations of the immune system in these individuals.

Multiple Myeloma after Phenytoin Therapy

“…The occurrence of a monoclonal gammopathy after prolonged phenytoin therapy is rare. 2 cases of multiple myeloma have been previously reported (Clinicopathologic conference 1962, Matzner & Polliack 1978. In the case reported by Lapes et a1 (1976b), the serum protein analysis of a phenytoinassociated immunoblastic lymphadenopathy showed 2 monoclonal immunoglobulins.…”

“…Several cases of benign lymphadenopathy (Saltzstein & Ackerman 1959), malignant lymphoma (Anthony 1970, Rausing & Trell 1971, Bichel 1975, Li et a1 1975, Rausing 1978, and angioimmunoblastic lymphadenopathy (Lapes et a1 1976b), have been related to long-term phenytoin administration. The occurrence of multiple myeloma during hydantoin therapy has been rarely reported (Matzner & Polliack 1978) and may be coincidental. A new case of this association is reported in a woman treated with daily phenytoin over a period of 4 years.…”