Pseudolymphoma

Other effects include Dupu5dren s contracture and pseudolymphoma. Some degree of macrocyto-sis is common but anaemia probably occurs only when dietary folate is inadequate. This responds to folate supplement (the requirement for folate is increased, as it is a cofactor in some hydroxylation reactions that are accelerated by enzyme induction by phenytoin). Osteomalacia due to increased metabolism of vitamin D occurs after years of therapy. 

The synonyms used for inflammatory pseudotumour include myofibroblastic inflammatory tumour, histiocytoma, pseudolymphoma, fibroxanthoma and plasma cell granuloma. This condition was first described by G.T. Pack et al. in 1953. It is a rare type of tumour (about 100 reports so far) which can occur at any age (but mainly between 30 and 40), with men being affected three times more often than women. The tumour mostly affects the liver (90%), but also numerous other organs (lung, stomach, parotis, pleura, ovaries, thyroid gland. 

Pseudolymphoma and a condition resembling malignant lymphoma occnr very rarely with phenytoin. There is no evidence of a significant increase in the incidence of other tumors. 

Pseudolymphoma and a condition resembling malignant lymphoma occur very rarely with phenytoin (SED-13, 142). There is no evidence of a significant increase in the incidence of other tumors. There have also been reports of pseudolymphoma with other antiepileptic drugs, including carbamazepine (147-149), lamotrigine (150), phenobarbital (151), and valproic acid (151). 

Cogrel O, Beylot-Barry M, Vergier B, Dubus P, Doutre MS, Merlio JP, Beylot C. Sodium valproate-induced cutaneous pseudolymphoma followed by recurrence with carbamazepine. Br J Dermatol 2001 144(6) 1235-8. 

Sinnige HA, Boender CA, Kuypers EW, Ruitenberg HM. Carbamazepine-induced pseudolymphoma and immune dysregulation. J Intern Med 1990 227(5) 355-8. 

Pathak P, McLachlan RS. Drug-induced pseudolymphoma secondary to lamotrigine. Neurology 1998 50(5) 1509-10. 

A 28-year-old woman taking bromocriptine 5 mg/day for a microprolactinoma developed numerous nodular skin lesions (16). Skin biopsy showed a polyclonal proliferation of both B and T Ijmphocytes in a follicular pattern, and a diagnosis of cutaneous pseudolymphoma was made. The lesions disappeared within 8 weeks of withdrawal. 

Wiesli P, Joos L, Galeazzi RL, Dummer R. Cutaneous pseudolymphoma associated with bromocriptine therapy. Clin Endocrinol (Oxf) 2000 53(5) 656-7. 

This seems to have been the first report of carbamazepine-induced histological features of cutaneous pseudolymphoma, including CD30+ cells. 

Carbamazepine and phenytoin have previously been associated with lymphoproliferative disorders, including dermatopathic lymphadenitis, atypical lymphoid proliferation, and cutaneous pseudolymphoma. In most reported cases, regression follows withdrawal of treatment with the causative drug. However, rarely true lymphoma can develop. 

Nathan DL, Belsito DV. Carbamazepine-induced pseudolymphoma with CD-30 positive cells. J Am Acad Dermatol 1998 38(5 Pt 2) 806-9. 

Pseudolymphoma leukemia (Sezary sjmdrome) has been reported to occur mainly after the nse of phenjdoin and other anticonvnlsant dmgs (89,90), bnt cefixime has also been implicated (91). 

The authors stressed that, like patients with phenytoin-induced pseudolymphoma, this patient will need longterm follow-up to differentiate true prelymphoma. This case can be taken as a reminder that every new beta-lactam coming on the market may have an adverse effects profile of its own. 

Rosenthal CJ, Noguera CA, Coppola A, Kapelner SN. Pseudolymphoma with mycosis fungoides manifestations, hyperresponsiveness to diphenyUiydantoin, and lymphocyte disregulation. Cancer 1982 49(11) 2305-14. 

DTncan M, Souteyrand P, Bignon YJ, Fonck Y, Roger H. Hydantoin-induced cutaneous pseudolymphoma with clinical, pathologic, and immunologic aspects of Sezary syndrome. Arch Dermatol 1992 128(10) 1371. ... 

Jabbar A, Siddique T. A case of pseudolymphoma leukaemia syndrome following cefixime. Br J Haematol 1998 101(1) 209. 

Fatal lymphocytic Ijmphoma has been described during high-dose dantrolene therapy (600 mg/day over 3 years) (9). Although the association was only circumstantial, another hydantoin derivative, phenjhoin, is known to cause pseudolymphoma. 

In contrast, there have been several isolated reports of methotrexate-induced lymphomas (SEDA-21, 388) (SEDA-22, 417) (115,116). The pathological features in these cases have ranged from benign lymphoid hyperplasia to non-Hodgkin s lymphoma, and more rarely Hodgkin s disease (115), and patients usually had the typical features of lymphoproliferative disorders as found in immunosuppressed patients, that is, transplant patients or patients with congenital or acquired immune deficiency syndromes. Exceptionally, cases of pseudolymphoma have also been reported (SEDA-21, 389). 

Cutaneous pseudolymphoma Acantholytic dermatosis (Grover s disease)... 

Pseudolymphoma and a condition resembling mahgnant lymphoma are very rare. 

Neuroblastoma has been rarely reported in association with the fetal hydantoin syndrome. Phenytoin can cause pseudolymphoma and rarely a condition resembling malignant lymphoma (SED-13, 142). Pseudolymphoma is usually characterized by lymphadenopathy, fever, and a diffuse erythematous macular skin eruption, although a presentation without fever and rash has been described (SEDA-20, 65). 

Jeng YM, Tien HF, Su U. Phenytoin-induced pseudolymphoma reevaluation using modern molecular biology techniques. Epilepsia 1996 37(l) 104-7. 

Leshin B +, IntJ Dermatol 28, 177 Nodular eruption Pseudolymphoma... 

Tally FP+, Pediatr Infect Dis J 6, 976 Pruritus ani et vulvae Pseudolymphoma... 

Caumes E +, Arch Dermatol 133, 465 (1997) Thaler D, Monona, Wl (from Internet) (observation) Pruritus ani et vulvae (1981) Modern Medicine 49, I I I Pseudolymphoma Psoriasis... 

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