Pityriasis rosea-like Drug Eruption Induced by Imatinib Mesylate (Gleevec™)

Abstract

Imatinib mesylate (Gleevec™, STI571), a selective inhibitor of BCR-ABL, c-Kit, and platelet-derived factor receptor, has been used to treat chronic myelogenous leukemia (CML) and gastrointestinal stromal tumors. Although its use has been associated with various adverse cutaneous reactions, pityriasis rosea-like drug eruptions are rare. Here, we report a case of pityriasis rosea-like drug eruption that developed following the administration of imatinib mesylate to treat CML.

Imatinib, dasatinib and nilotinib: a review of adverse cutaneous reactions with emphasis on our clinical experience

“…described a psoriasiform rash appearing mostly on the scalp, arms and trunk in 4 of 54 imatinib‐treated patients (two of them had a history of psoriasis) . Otherwise, the eruption can present with psoriasiform palmoplantar hyperkeratosis, pityriasiform eruptions and pityriasis rosea . We previously reported a series of three male patients who were treated with imatinib and developed an erythematous macular skin eruption on the trunk and arms, whose many lesions had a peripheral collarette of desquamation and a vaguely parallel distribution to Langer's skin lines, thus suggesting a clinical diagnosis of pityriasis rosea‐like drug eruption .…”

Reply: Commentary on letter to the editor from Drago et al

“… 2 Unfortunately, we did not evaluate our patient for the presence of HHV-6/7 serum antibodies or plasma DNA during the acute phase of the eruption. 3 , 4 , 5 , 6 Regarding peripheral eosinophilia, our patient had transient eosinophilia with absolute eosinophil count of 880. The presence of eosinophilia might support a drug-induced eruption; however, most of the PR-like eruptions present with normal eosinophil count.…”

Pityriasis rosea of Gibert: immunological aspects

“…57 Similar considerations may also apply to other cases occurred during therapy with TNF-alpha inhibitors, like etanercept 58 or infliximab. 59 More in general, several drugs were reported as causes of PR or PR-like skin rashes, [60][61][62] and the pathogenic mechanisms leading to this peculiar clinical presentation are largely unknown, mainly because of the usually anecdotal nature of such reports. Definitive evidence in favour of any of the proposed immunological or non-immunological mechanisms is lacking, and debate is still open.…”