[Diagnostic problems in hydantoin immunopathy. Review of the literature and description of 3 cases].

During phenytoin therapy, a male patient showed hypertermia, myalgias and mediastinal and abdominal lymphadenopathy. Despite the impossibility of histological diagnosis, he was treated with antiblastic polychemotherapy with little benefit. Another female patient on the same therapy showed splenomegaly with pancytopenia. The spleen and some abdominal lymph nodes were removed; they revealed a pattern of tubercular-like gigantocellular-epithelioid chronic flogosis. As in the first patient, the suspension of therapy gave a disease-free period. A third female patient on diphenylhydantoin therapy undervent some hemolytic crysis and, finally, SLE with cardiac involvement. We point out the complexity of the pathogenesis of hydantoinic immunologic syndromes, the polymorphism of the clinical patterns and the difficulty to make a correct diagnosis, mostly on presence exclusively deep involvement.