Hodgkin病類似の症状を呈したDiphenylhydantoin中毒症の1例

A CASE WITH HODGKIN'S DISEASE LIKE SYNDROME INDUCED BY DIPHENYLHYDANTOIN

　Diphenylhydantoinによつて惹起され，臨床的にも組織病理学的にもHodgkin氏病ときわめて類似した像を呈した稀有なる症例について報告した。

　Jacksonてんかんを主症状とするてんかん重積症によつて入院した25歳の男子患者に，Diphenylhydantoin （0.2→0.39／日）を投与したところ，8日目より38〜39℃の弛張熱を発し，重積発作が収まつても持続した。22日目より両頬部に血管腫様発疹，前胸部，上下肢伸展側に麻疹様紅疹を生じ，25日目より両側頸部，下顎，腋窩，鼠径部リンパ節の腫脹が表われ増強，32日目より好酸球増多が認められた。41日目に別出したリンパ節の組織像では，リンパ節の正常構造は失われ，内皮細網細胞の増生，核分裂像，好酸球，リンパ球の浸潤，多核巨細胞を認めHodgkin氏病の初期に類似していたが，Reed-Sternberg細胞は確認されなかつた。これらのHodgkin氏病類似の諸症状はDiphenylhydantoin投与の中止により約1カ月で消槌し，投薬中止後3カ月に至るも再燃の徴は認められない。

　なおこの症例を中心に，抗痙攣剤によるリンパ節腫脹症候群につき多少文献的考察を加えた。

A rare case was reported of diphenylhyda-ntoin poisoning clinically and histopathologic-ally mimicking Hodgkin's disease.

A 25-year-old male, admitted because of epileptic status, was treated by daily admini-stration of 0.2-0.3 grams of diphenylhydan-toin in combination with phenobarbital and chlordiazepoxide. The patient developed re-mittent fever on the 8th day of the treatment, and "butterfly" rash like erythema and mor-billiform rash on the 22nd day. On the 25th day the lymphnodes in the cervical, subman-dibular, axillar and inguinal regions of the both sides were enlarged and they became larger in size. At the same time eosinophilia in the peripheral blood was noted. Histopa-thological examination of the lymphnodes taken by biopsy revealed obliteration of the normal architecture, hyperplasia of the reticu-lum cells and other elements with frequent mitosis, infiltration with eosinophilic leuco-cytes and polynuclear giant cells, although no Reed-Sternberg cells were found. This Hodgkin's disease like syndrome was remitted within one month after cessation of diphenyl-hydantoin.

The similar syndrome introduced by anti-convulsant was reviewed and discussed.