Phillip Holland

Diphenylhydantoin-induced hypersensitivity reaction

A 2 1/2-year-old girl with phenylketonuria developed a severe hypersensitivity reactioncharacterized by generalized lymphadenopathy, hepatosplenomegaly, exfoliative dermatitis, and fever after a 13 day course of diphenylhydantoin. Evidence for this drug-induced disease being a hypersensitivity reaction of the delayed type is presented in that 10 months after her illness at least a portion of her blood lymphocytes recognized the drug as a previously encountered antigenic substance. An intriguing and unexplained aspect of her illness was the markedly impaired excretion of diphenylhydantoin. Interesting hematologic findings were a striking plasmacytosis of the blood and a mild hemolytic anemia.

Granulocyte response in acute leukemia

the relatively huge dose of amethopterin that is given to these children. Is it recovered? What part of it is excreted at what rate in the urine or in the stools? I t seems to me that one might expect rather severe results in the mucosa of the gastrointestinal tract from such a relatively huge single dose, but such changes were evidently not seen. Therefore I wonder how much of this dose is actually retained. J. PERmN, CINCINNATI. Dr. Condit has written several papers on this and done many studies. The drug is not excreted in toto for several weeks or months after these doses. There is a certain amount, in most instances a large amount, which is bound in the body tissues. However, after doses as high as 16 mg. per kilogram every 2 weeks, Condit found that the bone marrow recovered and that normal levels of folic acid were excreted in the urine in 2 or 3 days. In other words, the normal tissues and normal cells escape the enzyme block more readily than do the rapidly metabolizing leukemic cells.