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| CASE REPORT |
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| Year : 1994 | Volume
: 60
| Issue : 5 | Page : 306-307 |
Drug induced pseudolymphoma syndrome
RR Mittal, C Jain, RLS Walia, Arun Chopra
Correspondence Address:
R R Mittal
 Source of Support: None, Conflict of Interest: None  | Check |
Five cases of pseudolymphoma syndrome (PS) in children aged 6 to 12 years were observed after anticonvulsant drugs. In 2 cases PS was observed after 10 days and in 3 after 15 days therapy with offending drug. 3 cases of PS were due to carbamazepine and had morbilliform rash and 2 cases due to phenobarbitone had erythroderma. All had fever, generalised lymphadenopathy and 4/5 had hepatosplenomegaly. Therapy with 15 mg prednisolone daily and withdrawal of offending drug led to cure in 4/5 cases and 1 died due to congestive cardiac failure.
Keywords: Pseudolymphoma syndrome, Anticonvulsant drugs
How to cite this article:
Mittal R R, Jain C, Walia R, Chopra A. Drug induced pseudolymphoma syndrome. Indian J Dermatol Venereol Leprol 1994;60:306-7 |
How to cite this URL:
Mittal R R, Jain C, Walia R, Chopra A. Drug induced pseudolymphoma syndrome. Indian J Dermatol Venereol Leprol [serial online] 1994 [cited 2020 Nov 24];60:306-7. Available from: https://www.ijdvl.com/text.asp?1994/60/5/306/4087 |
| Introduction | |  |
The pseudolymphoma syndrome (PS) consists of the triad of fever, generalised rash and lymphadenopathy. In addition malaise, hepatosplenomegaly, arthralgia, congestive cardiac failure, eosinophilia, thrombocytopenia and blood dyscrasias may be present. [1] Diphenylhydantoin, mephytoin, tridione and phenobarbitone etc. can produce a peculiar response of reticuloendothelial system resulting in PS. [2] PS may be either hypersensitivity reaction or possibly a genetically determined enzymatic defect as seen in primaquin sensitivity. [3] P S may present as generalised exfoliative dermatitis. [4] P S may have generalised or localised lesions and may result from non-anticonvulsant drugs. [5] Histopathology may reveal mycosis fungoides or sezary like syndrome. [4],[5],[6]
| Case Report | | |
Case 1
One 10-years-boy tolerated phenobaroitone (60 mg twice/day) for 1/ 2 half years and was shifted to carbamazepine (200 mg twice/day). 10 days later he developed fever, hepatosplenomegaly, generalised erythematous maculopapular rash and generalised lymphadenopathy. Lymph nodes were 1 to 2.5 cm, discrete, mobile, firm and nontender. Fever subsided and lymphadenopathy started regressing within 4 days of starting 15 mg prednosolone daily. All investigations were normal except TLC which was 22,000/ cmm.
Case 2
One 12-years-female tolerated phenobarbitone for the last 8 years and was shifted to carbamazepine (200 mg twice day). 15 days later she developed low grade fever, generalised erythematous maculopapular rash and generalised lymphadenopathy (2-3 cm, discrete, mobile, firm and non-tender). Mantoux test was positive. ESR was 80 mm. X-ray chest revealed hilar lymphadenopathy and was diagnosed as a case of tuberculosis. Lymph node biopsy ruled out tuberculosis. Peripheral smear showed occasional atypical lymphocytes. Dermatologists recognised pseudolymphoma syndrome and was treated after 2 weeks therapy with 15 mg prednisolone daily.
Case 3
One 10-years-female had febrile convulsions and was given carbamazepine (200 mg twice/day). After 2 weeks therapy, she developed low grade fever, generalised morbilliform rash with interspersed purpura, ecchymosis, haemorrhagic bullae, hepatosplenomegaly and visible generalised lymphadenopathy (2-4 cm, discrete, firm, mobile and non-tender). All investigations were normal except presence of occult blood in stool and platelet counts which were 60,000/ cmm. Carbamazepine was deleted and patient was given 15 mg prednisolone daily and within 3 days haemorrhagic bullae and purpura subsided and lymph nodes started regressing. Patient was treated after 2 weeks therapy.
Case 4
One 10-years-boy had febrile convulsions and was given phenobarbitone (60 mg twice/ day). 15 days later he developed high grade fever, erythroderma and generalised lymphadenopathy. Liver was enlarged by two fingers and spleen was just palpable. Hb was 8.0 gm%. DLC showed P 30, L 50, M 2 and E 18. ESR was 108 mm. Other investigations were normal. Child was given 2 cc intramuscularly Dexamethasone daily. On 5th day child developed congestive cardiac failure and died.
Case 5
One 6-years-male was given phenobarbitone (60 mg twice/day) and 10 days later developed fever, erythroderma, heaptosplenomegaly and generalised lymphadenopathy. On 4 day, he developed malena. Hb was 7.5 mg%. TLC was 11,400/ cmm. DLC was: P 40, L 39, E 20 and M L. Stools for occult blood was positive. Other investigations were normal. Patient was treated with 2 cc intramuscular Dexamethasone daily. He started improving on 4 day and was treated after 2 weeks therapy.
| Comments | | |
Pseudolymphoma syndrome in 5 children were observed. 3 were due to carbamazepine and 2 due to phenobarbitone. 2 cases with phenobarbitone had erythroderma, other 3 cases had morbilliform rash and one of them had additional purpura, haemorrhagic bullae and thrombocytopenia. All the cases occurred within 2 weeks of starting offending drug. It has been reported that P S occurs within 2 to 8 weeks of starting therapy with diphenylhydantoin. [7] Due to fever, lymphadenopathy and rash, the P S has to be differentiated from viral and bacterial infections. Early diagnosis is very important as it can easily be treated by systemic steroids and omitting the offending drugs.
| References | | |
| 1. | Sparberg M. Diagnostically confusing complications of diprhenylhydantoin therapy: A review. Ann Int Med 1963; 59: 914-30.  [PUBMED] |
| 2. | Schreiber MM, McGragoor JG. Pseudolymphma syndrome: A sensitivity to anticonvulsant drugs. Arch Darmatol 1968; 97: 297-300. |
| 3. | Braverman IM, Levin J. Dilantoin-induced serum sickness. Amer J Med 1963; 35:418. [PUBMED] |
| 4. | Rosenthal CJ, Noguera CA, Coppola A, et al. Pseudolymphoma with mycosis fungoides manifestations hyper-responsiveness to diphenylhydantoin and lymphocyte disregulation. Cancer 1982; 49: 2305-14. [PUBMED] |
| 5. | Kardaun SH, Scheffer E, Vermeer BJ. Druginduced pseudolymphomatous skin reactions. Brit J Dermatol 1988; 118: 54552. [PUBMED] |
| 6. | Charlesworth EN. Phenytoin-induced pseudolymphoma syndrome. Arch Dermatol 1977; 113: 477-80. [PUBMED] |
| 7. | Michel D'Incan, Southeyrand P, Bignon YJ, Froncky Roger H. Hydantoin-induced cutaneous pseudolymphoma with clinical pathologic and immunologic aspects of sezary syndrome. Arch Dermatol 1992; 128: 1371-4. |
| This article has been cited by | | 1 |
Carbamazepine induced pseudo-lymphoma syndrome |
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| Paramesh, H., Satish, D.A., Khatib, S.A., Mukta Jain, M. | | Indian Pediatrics. 1997; 34(9): 829-831 | | [Pubmed] | |
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