Sodium valproate-induced cutaneous pseudolymphoma followed by recurrence with carbamazepine.
We report a patient with a sodium valproate-induced cutaneous pseudolymphoma, presenting with an erythematous papule, histologically mimicking a non-epidermotropic T-cell lymphoma. Polymerase chain reaction study of the skin biopsy revealed monoclonal rearrangement of the T-cell receptor gamma gene. Withdrawal of sodium valproate was followed by regression of the lesion, but 5 months after substitution by carbamazepine, two further papules appeared, with similar histological features and a T-cell clone identical to the initial one. Carbamazepine was stopped and the lesions disappeared without relapse over a 4-year follow-up. Sodium valproate is very rarely responsible for a hypersensitivity syndrome, and our case is the first report of sodium valproate-induced cutaneous pseudolymphoma. The recurrence with carbamazepine may be due to a common effect on T-cell lymphocyte function. The return of the same monoclonal population shows that the recurrence of monoclonal T cells may be observed in benign conditions and is not an exclusive hallmark of cutaneous lymphoma.
Cogrel
O
O
Department of Dermatology, Hôpital Haut-Lévêque, CHU de Bordeaux et EA 2406, Université Victor Segalen Bordeaux 2, France.
Beylot-Barry
M
M
Vergier
B
B
Dubus
P
P
Doutre
M S
MS
Merlio
J P
JP
Beylot
C
C
D000328:Adult; D000927:Anticonvulsants / Q000009:adverse effects*; D002220:Carbamazepine / Q000009:adverse effects*; D003875:Drug Eruptions / Q000209:etiology* / Q000473:pathology; D006801:Humans; D008297:Male; D019310:Pseudolymphoma / Q000139:chemically induced* / Q000473:pathology; D012008:Recurrence; D014635:Valproic Acid / Q000009:adverse effects*
D000927:Anticonvulsants; D002220:Carbamazepine; D014635:Valproic Acid