A rare case of imatinib-induced erythroderma
A 52-year-old male presented to the medical outpatient department with complaints of low grade fever and lump on the left side of abdomen since one month duration. Investigations revealed total leukocyte count of 1.2 lakhs/mm3. Bone marrow examination revealed 2% blast cells, serum lactate dehydrogenase was 1134 IU/L, and an ultrasound of the abdomen revealed splenomegaly with span of 19 cm. Chromosomal studies revealed a bcr– abl gene rearrangement. The case was diagnosed as CML in chronic phase and patient was prescribed imatinib mesylate 400 mg once daily.\nTen days later, he developed redness and scaling involving dorsum of both hands which increased to involve his entire body over a period of 20 days. The lesions were associated with severe itching. There was no history of any other drug intake, or history of fever, jaundice, chest pain, palpitation and dyspnoea on exertion. Imatinib was continued and the rash worsened.\nWhen the patient was referred to us, he had generalized skin rash of 40 days duration. General physical examination was unremarkable while systemic examination revealed splenomegaly, 3 cm below costal margin. Dermatological examination revealed generalized involvement of the body in form of dusky, blanchable erythema, and diffuse fine scaling. Lichenification was noted in flexures viz groin, axillae and neck [Figures and ]. Angular cheilitis was present. Ophthalmological examination revealed periorbital edema with conjunctival congestion and loss of eyelashes. Nails showed transverse hyperpigmented bands at the same level in all nails. Investigations revealed hemoglobin of 14.5 gm%, total leukocyte count 11,500/mm3, and differential count was polymorphs- 50, lymphocytes- 8, monocytes- 2, and eosinophils 40. Urine examination, blood sugar, renal, and liver function tests were within normal limits.\nImatinib was immediately stopped and patient was prescribed on tablet prednisolone 40 mg/day, which was maintained at full dose for two weeks, tapered by 10 mg every week, and stopped after a total of five weeks. Supportive measures including high protein diet, appropriate temperature control, fluid, and electrolyte balance were provided. Improvement was noted with decreased erythema on fifth day and significant reduction in scaling by day 11. The rash disappeared completely within three weeks. The patient was changed to an alternative anti-CML medication (Cyclophosphamide based) and rechallenge or desensitization was not resorted to, as erythroderma is considered a severe form of drug reaction.