Diphenylhydantoin-induced serum sickness with fibrin-platelet thrombi in lymph node microvasculature

Am J Med. 1975 May;58(5):704-8. doi: 10.1016/0002-9343(75)90507-0.


In this 16 year old boy a syndrome, characterized by high fever, generalized lymphadenopathy, splenomegaly, diffuse skin rash, facial and periorbital edema, neutropenia, thrombocytopenia, elevated serum glutamic oxaloacetic transaminase (SGOT) levels and transient electrocardiographic changes, appeared 2 weeks after the institution of diphenylhydantoin therapy. Lymph node biopsy, performed at the height of the illness, revealed widespread subendothelial fibrin exudation and fibrin-platelet thrombi in the lymph node microvasculature, a finding most consistent with thrombotic thrombocytopenic purpura. Although many types of abnormal lymph node histology have been described with diphenylhydantoin, this appears to be the first instance of this histologic picture. This syndrome may be related to a serum sickness-like illness which triggered an episode of localized coagulopathy.

Publication types

  • Case Reports

MeSH terms

  • Acute Disease
  • Adolescent
  • Blood Coagulation Disorders / chemically induced
  • Blood Coagulation Disorders / pathology
  • Drug Hypersensitivity*
  • Humans
  • Lymph Nodes / blood supply
  • Lymph Nodes / pathology
  • Male
  • Microcirculation / pathology
  • Phenytoin / adverse effects*
  • Phenytoin / immunology
  • Purpura, Thrombotic Thrombocytopenic / chemically induced*
  • Purpura, Thrombotic Thrombocytopenic / pathology
  • Seizures / drug therapy
  • Serum Sickness / etiology*
  • Serum Sickness / pathology
  • Thrombosis / pathology


  • Phenytoin