Hydantoin-Induced Cutaneous Pseudolymphoma With Clinical, Pathologic, and Immunologic Aspects of Sézary Syndrome

Abstract

Although lymph node pseudolymphomas induced by phenytoin are well known, few cases of hydantoin-induced mycosis fungoides have been reported in the literature. We present herein the first case of a Sézary-like syndrome associated with phenytoin therapy. Such a patient must be monitored regularly because of the risk of a true malignant lymphoma developing even many years later.

The solitary lymphomatous papule, nodule, or tumor

“…Phenytoin use such as in patient 7 has been linked to reactive lymphoid infiltrates and lymphomas, including MF-like lesions. [31][32][33][34] The cutaneous disorders diagnosed in this series do not classically present as solitary lesions. MF does not commonly present as a solitary lesion but rather as multiple patches and plaques.…”

Drug-induced cutaneous pathology

“…Histologically, there is a predominant dense dermal infiltrate of lymphocytes and admixed plasma cells and eosinophils (fig 10). Epidermotropism and mucinous follicular degeneration are also documented 64 66 67. There is immunohistochemical and molecular B and T cell pseudoclones 64.…”

Drug-Induced Pseudolymphoma and Hypersensitivity Syndrome

“…6 As a dense lymphocytic infiltration of the dermis can be observed in both clinical situations, the denominations pseudolymphoma and hypersensitivity syndrome have been alternatively used for similar patients.7"14 The nosological characteristics of these drug eruptions appears to be confusing. 15 We analyzed a series of 24 [17][18][19] hypothesis that the 2 originally described entities retain their autonomy and to see if there are really 2 distinct entities.…”