DRUG‐ASSOCIATED LYMPHADENOPATHIES WITH SPECIAL REFERENCE TO THE REED–STERNBERG CELL

This paper describes the case of a female octoroon, aged 22 years, who had been on “Dilantin” for 14 years when she developed Hodgkin's disease. The diagnosis was made on the histological appearances of cervical lymph nodes, without prior knowledge that she was an epileptic. The known association of lymphadenopathies and anticonvulsant therapy prompted an Investigation Into the literature, and this revealed (Table 1) an interesting evolutionary development of thought (from 1940 to 1969) with regard to drug‐induced lymphadenopathies. A characteristic clinical syndrome (of adenopathy associated with signs and symptoms of drug reaction) is described and two new syndromes emerge, namely, pseudolymphoma and pseudopseudolymphoma. It becomes clear that there is a “spectrum of lymphoid reactions”, ranging from hyperplasia through to neoplasia, which can be associated with anticonvulsant therapy. Out of this, too, comes the realization that the Reed‐Sternberg cell, which is discussed in relation to these entities, once considered, and for so long, to be the sine qua non of Hodgkin's disease, probably no longer can remain the criterion of this diagnosis. As early as 1963, writers were beginning to doubt That the presence of Reed‐Stenberg cells always indicated Hodgkin's disease, and by 1969 it appeared quite strongly that the reliability of their presence as the Infallible diagnostic feature of this disease was no longer tenable.