Reactive lymphohistiocytosis with recurrence in the optic chiasm.
Histiocytic infiltration of the optic chiasm is rare. We report a patient with a seizure disorder on anticonvulsant therapy, who developed systemic reactive histiocytosis. Treatment with splenectomy, corticosteroids, and anticonvulsant medication change resulted in clinical remission. The patient later developed recurrent lymphohistiocytosis restricted to the optic chiasm. Extensive re-evaluation yielded no evidence for infectious or malignant etiology. Radiation therapy and withdrawal of anticonvulsant therapy resulted in clinical remission. We conclude that both phenytoin and phenobarbital may trigger a lymphohistiocytic process and that infiltration of the visual pathway is possible.
Galetta
S L
SL
Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia 19104.
Stadtmauer
E A
EA
Hicks
D G
DG
Raps
E C
EC
Plock
G
G
Oberholtzer
J C
JC
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D003389:Cranial Nerve Diseases / Q000473:pathology*; D015616:Histiocytosis, Non-Langerhans-Cell / Q000473:pathology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009897:Optic Chiasm / Q000473:pathology*; D010634:Phenobarbital / Q000009:adverse effects / Q000627:therapeutic use; D010672:Phenytoin / Q000009:adverse effects / Q000627:therapeutic use; D012008:Recurrence; D012640:Seizures / Q000188:drug therapy
D000305:Adrenal Cortex Hormones; D010672:Phenytoin; D010634:Phenobarbital