[Drug reaction with eosinophilia and systemic symptoms (DRESS) following imatinib therapy].
BACKGROUND
Imatinib (Gleevec) is a tyrosine kinase inhibitor used to treat chronic myeloid leukemia. We describe a case of drug reaction with eosinophilia and systemic symptoms (DRESS) after institution of treatment with imatinib.


METHODS
A 78-year-old woman was treated with low-dose imatinib for chronic myeloid leukemia since November 2003. A macular and pruritic eruption appeared on the patient's trunk after 7 weeks of treatment and gradually worsened. After 1 month, she was admitted for generalized skin eruption with fever and diffuse lymphadenopathy. Laboratory data showed hypereosinophilia and blood cultures positive for Staphylococcus aureus. Imatinib was stopped and replaced with hydroxyurea (Hydrea). Improved clinical and laboratory results were seen with antibiotics and topical steroids.


CONCLUSIONS
To our knowledge, this is the first case of DRESS following treatment with imatinib. Cutaneous reactions to imatinib are frequent and are usually mild, comprising maculopapular eruption, pruritus and facial edema. Few cases of serious skin reactions have been reported until now. Several authors suggest that the prevalence and severity of cutaneous manifestations are related to a pharmacologic effect of imatinib. Our observation cannot rule out an underlying immunologic mechanism. Septicemia may also play a part in the development of DRESS.
Le Nouail
P
P
Service de Dermatologie et Vénéréologie, Hôpital Sud, Amiens, France. patricialenouail@yahoo.fr
Viseux
V
V
Chaby
G
G
Billet
A
A
Denoeux
J P
JP
Lok
C
C
D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects*; D016470:Bacteremia / Q000382:microbiology; D001549:Benzamides; D003875:Drug Eruptions / Q000209:etiology*; D004802:Eosinophilia / Q000139:chemically induced*; D005076:Exanthema / Q000139:chemically induced; D005260:Female; D006801:Humans; D000068877:Imatinib Mesylate; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000188:drug therapy; D010879:Piperazines / Q000009:adverse effects*; D047428:Protein Kinase Inhibitors / Q000009:adverse effects*; D011505:Protein-Tyrosine Kinases / Q000037:antagonists & inhibitors*; D011537:Pruritus / Q000139:chemically induced; D011743:Pyrimidines / Q000009:adverse effects*; D013203:Staphylococcal Infections / Q000175:diagnosis; D013577:Syndrome
D000970:Antineoplastic Agents; D001549:Benzamides; D010879:Piperazines; D047428:Protein Kinase Inhibitors; D011743:Pyrimidines; D000068877:Imatinib Mesylate; D011505:Protein-Tyrosine Kinases