[Imatinib-induced DRESS].
BACKGROUND
Imatinib (Glivec) is a tyrosine kinase inhibitor used to treat certain cases of leukaemia. We report a case of a drug-induced reaction with eosinophilia and systemic symptoms (DRESS) caused by imatinib.


METHODS
A 77-year-old woman with a chronic myeloid leukaemia was treated with imatinib and allopurinol. Nineteen days after the start of treatment, the patient presented fever with a generalized polymorphous rash associated with oral erosions, facial oedema, diffuse lymphadenopathy and blood hypereosinophilia. Histological analysis of skin biopsy specimens suggested a drug-induced reaction. The outcome was favourable two weeks after discontinuation of treatment. Three months later, imatinib was reintroduced because of progression of the patient's chronic myeloid leukaemia, and recurrence of the skin rash and fever was observed within 12 hours.


CONCLUSIONS
Allopurinol was stopped definitively because of its more frequent imputability. Imatinib was reintroduced after considering the benefit-risk ratio and in full knowledge of the existence of cutaneous reactions to imatinib, despite there being only one recent report of DRESS following treatment with imatinib. According to the causality criteria of Bégaud et al. regarding imatinib, inherent causality of the drug in our patient was initially possible (I2) and appeared likely (I3) after the rechallenge test. This case clearly illustrates that imatinib is a potential cause of DRESS.
Goldman
J
J
Clinique dermatologique, CHU de Rouen, 1 rue de Germont, Rouen, France.
Duval-Modeste
A-B
AB
Lambert
A
A
Contentin
N
N
Courville
P
P
Musette
P
P
Joly
P
P
D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects*; D001549:Benzamides; D004342:Drug Hypersensitivity / Q000209:etiology*; 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; D011743:Pyrimidines / Q000009:adverse effects*; D012867:Skin / Q000187:drug effects / Q000473:pathology*; D012871:Skin Diseases / Q000139:chemically induced / Q000276:immunology
D000970:Antineoplastic Agents; D001549:Benzamides; D010879:Piperazines; D047428:Protein Kinase Inhibitors; D011743:Pyrimidines; D000068877:Imatinib Mesylate