Lobular neutrophilic panniculitis associated with DNA methyltransferase inhibitors in the treatment of myeloid disease

Coleman, Emily; Panse, Gauri; Cowper, Shawn E.; Prébet, Thomas; Gore, Steven D.; Leventhal, Jonathan S.

doi:10.1111/cup.13537

Cited by 5 publications

(3 citation statements)

References 22 publications

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“…Erythema nodosum is known to occur with certain drugs such as oral contraceptives, nonsteroidal anti‐inflammatory drugs, and antibiotics. There are many reports documenting associations of chemotherapeutic and biological therapeutic agents with EN such as tumor necrosis factor (TNF) inhibitors, BRAF inhibitors, tyrosine kinase inhibitors, and immune checkpoint modulators 11–22 …”

Section: Discussionmentioning

confidence: 99%

“…There are many reports documenting associations of chemotherapeutic and biological therapeutic agents with EN such as tumor necrosis factor (TNF) inhibitors, BRAF inhibitors, tyrosine kinase inhibitors, and immune checkpoint modulators. [11][12][13][14][15][16][17][18][19][20][21][22] Dasatinib is a TKI known to cause several cutaneous toxicities mostly localized and generalized erythema, papular eruptions, and pruritus. 23 Rare cases of panniculitis have been described in patients treated with dasatinib.…”

Section: Discussionmentioning

confidence: 99%

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Erythema nodosum following treatment with dasatinib plus chemotherapy in a patient with myeloid blast phase of chronic myeloid leukemia

Kassem,

Alshurafa,

Elsabah

et al. 2023

Clinical Case Reports

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Key Clinical MessageErythema nodosum (EN) is a type of panniculitis occurring due to various conditions. It can be associated with certain malignancies or manifest as a side effect of drugs. This article presents a unique case of EN in a patient with chronic myeloid leukemia (CML‐blast phase) following dasatinib and chemotherapy. Timely recognition and appropriate management are crucial to alleviate symptoms and consider potential drug‐induced etiology.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Erythema nodosum following treatment with dasatinib plus chemotherapy in a patient with myeloid blast phase of chronic myeloid leukemia

Kassem,

Alshurafa,

Elsabah

et al. 2023

Clinical Case Reports

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“…By formal assessment of probability, the Naranjo Adverse Drug Reaction Probability score 5 was 8 (supplementary material), indicating a probable adverse reaction (range 5–8). A review of the literature provided rarely documented similar cases, including two cases of EN-like eruption after azacitidine 6 and one case after sorafenib 7 (Table 1). Although fungal infections and leukemia cutis are the top differentials considered for skin nodules in a patient with active AML, EN, in the right clinical context, should be considered.…”

Section: Discussionmentioning

confidence: 99%

Erythema nodosum after azacitidine in a patient with acute myeloid leukemia

Nasrollahi

Giubellino

Rashidi

2022

J Oncol Pharm Pract

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Introduction Nodular skin lesions in patients with acute myeloid leukemia (AML) raise clinical suspicion for leukemia cutis versus fungal infections. Here, we report a rare case of treatment-related erythema nodosum (EN) in a patient with AML. Case Report Approximately 5 weeks after the initiation of sorafenib and one week after azacitidine initiation, a 32-year-old man with primary refractory AML presented with several painful red nodules on the lower extremities. Histological examination established a diagnosis of EN. Management and Outcome Treatment with topical and oral steroids led to complete resolution of the nodules. However, once the dose of steroids was reduced, the lesions rapidly recurred. Higher dose steroids were reinitiated, again with a resolution of the nodules, confirming steroid responsiveness of the underlying process. Discussion Given the onset of lesions one week after the initiation of azacitidine and 5 weeks after the initiation of sorafenib, azacitidine was considered the more likely culprit. Only 2 cases of EN-like eruption after azacitidine and 1 case after sorafenib have been reported. Although fungal infections and leukemia cutis are the top differentials considered for skin nodules in a patient with AML, EN should be considered as an alternative diagnosis. Correct diagnosis is critical because it will guide treatment.

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Panniculitis

Requena,

Cerroni

2024

Rook's Textbook of Dermatology

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The panniculitides represent a group of heterogeneous inflammatory diseases that involve the subcutaneous fat. The specific diagnosis of these disorders requires histopathological study because different panniculitides usually show monotonous clinical appearance, namely subcutaneous erythematous nodules on the lower extremities. Histopathological study of panniculitis is also challenging because of an inadequate clinicopathological correlation and the evolutionary nature of the lesions. Often, biopsy specimens are taken from late‐stage lesions, which results in non‐specific histopathological findings. In addition, large‐scalpel incisional biopsies are required. However, with adequate biopsy samples a histopathological differential diagnosis between a mostly septal and a mostly lobular panniculitis is straightforward and with adequate clinicopathological correlation, a specific diagnosis may be rendered in most cases of panniculitis. Mostly septal panniculitides with vasculitis include superficial thrombophlebitis and cutaneous polyarteritis nodosa (cutaneous arteritis). Septal panniculitides with no vasculitis may appear as the consequence of dermal inflammatory processes extending to the subcutaneous fat, such as necrobiosis lipoidica, scleroderma, subcutaneous granuloma annulare, rheumatoid nodule and necrobiotic xanthogranuloma, whereas in other cases the inflammatory process involves primarily the connective tissue septa of the subcutis with no participation of the overlying dermis. The most frequent septal panniculitis is erythema nodosum. In contrast, the most common lobular panniculitis with vasculitis is erythema induratum of Bazin (nodular vasculitis). Mostly lobular panniculitides without vasculitis comprise a large list of disorders, including sclerosing panniculitis (lipodermatosclerosis), subcutaneous fat necrosis of the newborn, panniculitis associated with connective tissue diseases, pancreatic panniculitis, 1 ‐antitrypsin deficiency‐associated panniculitis, infective panniculitis and factitious panniculitis. In recent years, several cases of both septal and lobular panniculitis have been described as a consequence of the administration of new drugs, including immune checkpoint inhibitors and BRAF inhibitors used as treatment of metastatic melanoma, tyrosine kinase and Bruton tyrosine kinase inhibitors used for treatment of leukemia and other haematological malignancies and tumour necrosis factor inhibitor drugs.

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Lobular neutrophilic panniculitis associated with DNA methyltransferase inhibitors in the treatment of myeloid disease

Cited by 5 publications

References 22 publications

Erythema nodosum following treatment with dasatinib plus chemotherapy in a patient with myeloid blast phase of chronic myeloid leukemia

Erythema nodosum following treatment with dasatinib plus chemotherapy in a patient with myeloid blast phase of chronic myeloid leukemia

Erythema nodosum after azacitidine in a patient with acute myeloid leukemia

Panniculitis

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