PHENYTOIN-ASSOCIATED LYMPHOADENOPATHY MIMICKING A PERIPHERAL T-CELL LYMPHOMA

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Mark E. Johns
Lynn C. Moscinski
Lubomir Sokol *
(*) Corresponding Author:
Lubomir Sokol | lubomir.sokol@moffitt.org

Abstract

We report a case of phenytoin-induced pseudolymphoma in a 28-year-old male with a history of autism and seizure disorder.  The patient presented with bilateral cervical lymphadenopathy that was shown to be moderately to markedly FDG-avid on a whole body PET/CT scan.  Flow cytometry analysis of peripheral blood and bone marrow mononuclear cells detected identical T cell population with aberrant immunophenotype.  Additionally, a TCR beta gene was found to be clonally rearranged in both peripheral blood and bone marrow supporting a clonal origin of atypical T cells. However, no such clonal population of T-cells could be detected in a pathologic specimen obtained from an excisional biopsy of one of the patient’s cervical lymph nodes. After discontinuing the patient’s phenytoin, his lymphadenopathy has nearly completely resolved and circulation clonal T cell population disappeared with 12 months of follow-up.

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Author Biographies

Mark E. Johns

1SMDC Medical Center , Duluth, MN, 55805

Lynn C. Moscinski

Department of  Pathology and Laboratory Medicine, Moffitt Cancer Center,  Tampa, FL, 33612.

Lubomir Sokol

3Department of Malignant Hematology, Moffitt, Cancer Center, Tampa, FL, 33612