Reactive Lymphohistiocytosis with Recurrence in the Optic Chiasm

A 30-year-old man was well unti11980, when he sustained a skull fracture and cerebra lcontusion, requiring phenytoin for post-traumatic seizure disorder. In January, 1988, he developed night sweats, fevers, abdominal pain, 13-pound weight loss and hepatosplenomegaly with pancytopenia. Subsequent liver and bone marrow biopsy were nondiagnostic. Spleen biopsy demonstrated a reactive histiocytic process. His symptoms and pancytopenia responded to prednisone therapy, with substitution of phenobarbital for phenytoin.