Generalized Lichenoid Drug Eruption Associated with Imatinib Mesylate Therapy
A 63-year-old man was referred to the dermatology department with a 3-week history of acute onset, raised, itchy, purple-colored fairly generalized skin lesions over his body. There was no history of blistering or ulceration over the lesions. Two months before the onset of the skin lesions the patient was put on monotherapy with imatinib mesylate (IM) (400 mg/day) for the treatment of CML. There was no history of allogenic bone marrow transplantation. Considering the skin eruption, IM had been discontinued ten days prior to his first dermatological consultation. According to the patient, stoppage of the drug led to mild improvement of the skin lesions. Cutaneous examination revealed numerous, well-defined, violaceous, discrete and coalescing papules and plaques over the limbs, abdomen, chest, and the back. A few scattered hyperkeratotic papules were present on his palms. The lesions exhibited koebnerisation on the chest wall. There was fine scaling but no evident vesiculation, oozing or crusting [Figures and ]. The mucosae as well as the nails and hair were uninvolved.\nLesional punch biopsy specimens were obtained from two different sites. Histopathological examination [Figures and ] of both the specimens showed similar features. Epidermis showed hyperkeratosis with focal parakeratosis, irregular acanthosis and focal wedge-shaped hypergranulosis. Focal basal cell degeneration and pigment incontinence were found. An upper dermal band-like infiltrate comprising mononuclear cells and eosinophils was present at the dermoepidermal junction. Multiple colloid bodies were noticed. Sparse perivascular infiltrates were also seen in the dermis. Serological tests for human immunodeficiency virus (HIV) and hepatitis B and C were negative.\nBased on the clinical presentation and histopathological examination, a diagnosis of generalized LDE associated with IM was made. According to the Naranjo probability scale for adverse drug reaction, this diagnosis was “highly probable”.[]\nThe patient was treated with topical clobetasol propionate (0.1%) cream application over the active skin lesions as well as oral antihistamines. Within a couple of weeks, almost all the lesions healed with residual post-inflammatory hyperpigmentation [] and new lesions stopped appearing. Since the type of the adverse cutaneous drug reaction was not life- threatening, IM was gradually re-introduced to achieve a dose of 400 mg/day by hemato-oncologists. The patient was advised regular dermatological follow-up. After re-introduction of imatinib, he had a few new lesions of LP over the next couple of months. However, he was being maintained on intermittent topical steroid application over the active lesions with excellent control of the skin condition.