Reactions 549 - 6 May 1995

SCarbamazepine

Pseudolymphoma: 2 case reportsCarbamazepine-induced pseudolymphoma occurred in 2

patients shortly after they began treatment with this agent forseizures and psychosis, respectively. In both patients,immunochemical and molecular studies confirmed the benignnature of the changes.

The first patient, a 47-year-old man, had a long history ofepilepsy that had been treated with diphenylhydantoin. Hismedication was changed to carbamazepine [Tegretol®] 600mg/day because of recurrent seizures. Eight days later, he washospitalised with fever and an itching maculopapular rashinvolving his upper limbs, chest and abdomen. Hissubmaxillary, subclavicular, axillary and inguinal lymph nodeswere enlarged. The patient had increased levels of eosinophils,serum alkaline phosphatase and γ-glutamyl transferase. Hisserum carbamazepine concentrations were in the therapeuticrange.

A skin biopsy showed signs of drug eruption withhyperkeratosis, infiltration of the epidermis by mononuclearcells and some basal keratinocytes with necrosis. Histologicalexamination of an axillary lymph node showed destruction ofthe node and multiple necrosis. These areas of necrosis wereinfiltrated by atypical polymorphic lymphoid cells, plasmacells, centroblasts and immunoblasts, some of which weresimilar to Hodgkin cells. Carbamazepine therapy waswithdrawn and within a few days the man was asymptomatic.Three months later he accidentally took 1 tablet ofcarbamazepine and developed a fever and skin eruption whichpersisted for 4 days.

The second patient, a 33-year-old woman, had been treatedfor several years with haloperidol and cyamemazine fordelusions and mood instability. One month after her treatmentwas modified with the introduction of carbamazepine 600mg/day (slow release), she was hospitalised with fever andexanthema. Her cervical, axillary and inguinal lymph nodeswere enlarged and she had evidence of haemolytic anaemia. Abone marrow specimen showed increased eosinophils,proerythroblasts and erythroblasts. Her liver function testswere elevated and she had signs of jaundice. Histologicalexamination of an inguinal lymph node showed alterations ofthe cortical and paracortical area, disappearance of lymphoidfollicles and hypertrophy of the interfollicular zone.

Carbamazepine was stopped and the woman becameafebrile. Her erythroderma disappeared but palmoplantardesquamation occurred. Her jaundice resolved within 8 daysand her laboratory tests normalised within 2 months.

Author comment: Carbamazepine-inducedpseudolymphoma is rare; to date 38 cases have been reportedin the literature.Rispal P, et al. Carbamazepine-induced pseudolymphoma. Report of two cases.Revue de Medecine Interne 16: 214-218, No. 3, 1995 [Summarised from atranslation of the original published in French] - France 800349910

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Reactions 6 May 1995 No. 5490114-9954/10/0549-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved