diphenylhydantoinによる悪性リンパ腫症例

DIPHENYLHYDANTOIN-INDUCED LYMPHADENOPATHY ASSOCIATED WITH HODGKIN'S DISEASE

　I．はじめに

　diphenylhydantoin（Aleviatin）は抗痙攣剤としてテンカン治療などに広く用いられている薬剤であるが，臨床上いろいろな副作用を示す場合があることが知られている。たとえば耳鼻咽喉科の教科書にも歯肉増殖症（歯肉ディランチン症）などが記載されているが，実際に臨床でみることは少ない。

　diphenylhydantoinによる副作用の1つとしてリンパ節症（lymphadenopathy）が注目されだしたのは比較的に最近のことである。その報告は少なく，わが国における耳鼻咽喉科領域での報告は著者が調べた範囲では未だみられない。

　A case of anticonvulsant-drug-induced lymphadenopathy associated with the Hodgkin's disease is reported. A 9-year-old boy had his first grand mal seizure at the age 4. Diphenylhydantoin therapy was started at that time. Consequently, in April, 1974, the patient developed a swelling in the left mandibular region. Fever or other symptom was not noted. In October 1975, the mandibular tumor was removed surgically.

　Histopathological examination of the removed specimen revealed the growth to be a lymph node consisting of diffuse proliferation of lymphocytes and atypical histiocytes with large vesicular and prominent nuclei.

　The lesion was diagnosed as a drug-induced lymphadenopathy. The diphenylhydantoin therapy was discontinued. But the patient, again, after a period 4 months, developed a large mass in theleft submandibular region. Biopsy of the mass was taken which showed a large number of giant cells, Sternberg-Reed types.

　The patient was finally diagnosed as Hodgkin's disease associated with drug-induced lymphadenopathy.