ABSTRACT
We report a case of isolated malignant lymphoma of the jejunum occurring 18 18 months after continuous diphenylhydantoin therapy for epilepsy. Although this association may be purely coincidental, we suggest a possible causal relationship between the two in light of current knowledge about the immunological aberrations that may be caused by prolonged administration of diphenylhydantoin in man.
Subject(s)
Epilepsy/drug therapy , Jejunal Neoplasms/chemically induced , Lymphoma, Large B-Cell, Diffuse/chemically induced , Phenytoin/adverse effects , Aged , Humans , Male , Phenytoin/therapeutic use , Time FactorsABSTRACT
Severe autoimmune hemolytic anemia is described as the presenting manifestation of malignant thymoma. The hemoglobin level was 5.7 g/dl, the direct IgG antiglobulin test (direct Coombs' test) was strongly positive and the indirect Coombs' test was weakly positive. Prompt remission of the hemolytic process was achieved by thymectomy combined with corticosteroid therapy; the hemoglobin level rose to 12.2 g/dl and both the direct and indirect Coombs' tests became negative. To our knowledge, this is the first case to be described in which autoimmune hemolytic anemia was the presenting manifestation of malignant thymoma. Autoimmune hemolytic anemia may be considered as a manifestation associated with malignant thymoma.
