Successful Treatment of Imatinib-Induced DRESS Syndrome Using Reslizumab without Cessation of Imatinib: A Case Report

Abstract

Drug reaction with eosinophilia and systemic symptoms (DRESS) is a severe cutaneous adverse drug reaction; reported cases are sometimes imatinib mesylate induced. The main treatment is the withdrawal of the causative drug, and most cases with imatinib-induced DRESS syndrome required withdrawal of imatinib. However, in such cases involving anticancer drugs, this may compromise cancer treatment. Herein, we report a patient with imatinib-induced DRESS syndrome that was successfully treated with reslizumab while continuing imatinib treatment. A 65-year-old female presented with facial edema and generalized skin rash after being given 400 mg imatinib 2 weeks ago for metastatic gastrointestinal stromal tumor. After stopping imatinib, the clinical symptoms improved. Imatinib desensitization was performed, and it was administered again. However, the clinical symptoms reappeared more severely 2 months after restart of imatinib, and the peripheral absolute eosinophil count increased to 1,690/μL. A diagnosis of imatinib-induced DRESS syndrome was made, based on the Registry of Severe Cutaneous Adverse Reactions (RegiSCAR) criteria. Imatinib desensitization was repeated, but the clinical symptoms reappeared, and the peripheral eosinophilia persisted. We administered reslizumab, an interleukin-5 monoclonal antibody, without cessation of imatinib. The absolute eosinophil count decreased immediately, and the clinical symptoms improved gradually. After 2 weeks, the clinical symptoms reappeared mildly, but after administering reslizumab again, these disappeared completely. Reslizumab can be considered in the management of DRESS syndrome in cases wherein the causative medication needs to be continued.

Treatment with IL5-/IL-5 receptor antagonists in drug reaction with eosinophilia and systemic symptoms (DRESS)

“…In the current literature, only one case has been published [ 29 ]. Interestingly, the authors described that the suspected causing drug, imatinib, could be reintroduced under the treatment of IL‑5 blockade.…”

“…Three individuals were included in our study, one refused to participate (Table 1). The PubMed-Medline search revealed 11 cases published with DRESS and treated with anti-IL5 drugs (Table 2; [22][23][24][25][26][27][28][29]). Of the 14 cases, 6 were treated with mepolizumab, 6 with benralizumab, 1 with reslizumab, and 1 was switched from benralizumab to mepolizumab during the DRESS disease course.…”

“…An interesting observation is the one case with DRESS who tolerated imatinib, the putative DRESS-causing drug, for at least 2 years after treatment with reslizumab, even after discontinuation of IL‑5 blockade [ 29 ]. Unfortunately, no workup was performed to confirm imatinib as the causative drug.…”

“…Although IL-5 axis targeted treatments are used nowadays in numerous TH-2-mediated diseases, there are few reports concerning their use in eosinophilic complications such as drug hypersensitivity reactions. To date, 11 case reports have been published, with 3 more cases from our database [22][23][24][25][26][27][28][29]. Currently, IL-5/IL-5R blockade is mainly used in refractory DRESS, in severe DRESS relapses, and in cases with severe organ manifestation.…”

“…All three drugs have a good safety profile without significant immunosuppression which is promising for potential and optimal steroidsparing agents in DRESS [19][20][21]. To date, only single case reports of treatment success with anti-IL-5 drugs in DRESS have been published [22][23][24][25][26][27][28][29]. The aim of this study is to report our experience with anti-IL5 therapy in DRESS and to summarize the current literature.…”