Pure red cell aplasia, toxic dermatitis and lymphadenopathy in a patient taking diphenylhydantoin.

A patient taking diphenylhydantoin for 3 weeks developed a generalized skin rash, lymphadenopathy and pure red cell aplasia. After withdrawal of the pharmacon all symptoms disappeared spontaneously. Skin rash is a well-known complication of diphenylhydantoin treatment as is benign and malignant lymphadenopathy. Pure red cell aplasia associated with diphenylhydantoin medication has been reported in 3 patients. The exact mechanism by which diphenylhydantoin exerts its toxic effects is not known. In this patient the time relation between the ingestion of diphenylhydantoin and the occurrence of the skin rash, lymphadenopathy and pure red cell aplasia is very suggestive of a direct connection.