Phenytoin-induced pseudolymphoma syndrome: an immunologic study

Abstract

In vitro and in vivo immunologic studies were performed on a 28-year-old woman with phenytoin sodium-induced pseudolymphoma syndrome. During the acute phase of the syndrome, the patient appeared immunologically depressed. Six months after resolution of lymphadenopathy, repeat studies demonstrated a return to immunologic competence. In vitro studies of the patient's lymphocytes when incubated with phenytoin failed to indicate a delayed hypersensitivity reaction to the drug; These findings suggest that the patient developed a clinical lymphatic proliferation at a time when she was immunologically depressed. This may result in an increased chance of a mutant malignant clone developing at a time when the immunosurveillance system is impaired and explains why a rare patient with this syndrome may develop a frank malignant lymphoma.

Severe Bilateral Cervical Lymphadenomegaly Associated with Ethosuximide

“…Severe lymphadenopathy associated with antiepileptic drugs is well documented and very few cases have been described as pseudolymphoma in patients taking phenytoin, carbamazepine, lamotrigine, and ethosuximide. [2][3][4][5][6] Our patient presented symptoms extremely similar to the ones described by Masruha et al, 6 except for the duration of treatment before symptoms (2 weeks vs. 3 months). Both patients did not present liver abnormalities and had excellent prognosis after the drug was tapered off.…”

Clinicopathological and genotypic aspects of anticonvulsant-induced pseudolymphoma syndrome

“…in 1950 1 . Its pathogenesis has not been clearly understood, but it has been described as a hypersensitivity reaction due to anticonvulsants 2,3 . Clinically it is characterized by findings such as erythematous patch, maculopapular eruption or nodules developing within 2–3 weeks after administering causative agents, and systemic fever of 38–39 °C, lymphadenopathy, arthralgia, hepatosplenomegaly, abnormal liver profile and eosinophilia.…”

Sézary Syndrome Associated with Phenytoin Therapy

“…No Sezary cells were seen in the peripheral blood. In all of these cases and in the case described by Charlesworth [24], mycosis-fungoides-like pseudolymphoma syndrome regressed after cessation of therapy.…”