title: Cutaneous, Purpuric Painful Nodules Upon Addition of Ibrutinib to RCVP Therapy in a CLL Patient: A Distinctive Reaction Pattern Reflecting Iatrogenic Th2 to Th1 Milieu Reversal.
abstract: A 70-year-old white man with stage C chronic lymphocytic leukemia who was being successfully treated with ibrutinib and rituximab developed bilateral, purpuric, painful cutaneous nodules. Biopsies of these nodules did not reveal the usual Th2 milieu of chronic lymphocytic leukemia but instead exhibited a Th1-rich lymphocytic infiltrate with resultant neutrophil and granulomatous inflammation. The eruption resolved with drug cessation emphasizing the potential importance of this drug in treating conditions associated with Th2 dysregulation.
authors.affiliation: *Tri-Institutional MD-PhD Program, New York, NY; †Weill Cornell Medical College, New York, NY; ‡Ohio State University Comprehensive Cancer Center, New York, NY; §Phylogeny Labs, Inc, New York, NY; and ¶Department of Dermatopathology, New York Presbyterian Hospital, New York, NY.
authors.forename: Joseph Justin
authors.initials: JJ
authors.lastname: Mulvey
authors.forename: Gerard J
authors.initials: GJ
authors.lastname: Nuovo
authors.forename: Cynthia M
authors.initials: CM
authors.lastname: Magro
mesh_terms: D000225:Adenine / Q000031:analogs & derivatives; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D060890:B7-H1 Antigen / Q000032:analysis; D014408:Biomarkers, Tumor / Q000032:analysis; D001706:Biopsy; D004334:Drug Administration Schedule; D003875:Drug Eruptions / Q000209:etiology* / Q000276:immunology / Q000473:pathology; D006801:Humans; D007049:Iatrogenic Disease; D016756:Immunoglobulins, Intravenous / Q000008:administration & dosage; D016753:Interleukin-10 / Q000032:analysis; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000188:drug therapy* / Q000276:immunology / Q000473:pathology; D008297:Male; D009367:Neoplasm Staging; D010641:Phenotype; D010880:Piperidines; D047428:Protein Kinase Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D011720:Pyrazoles / Q000008:administration & dosage / Q000009:adverse effects*; D011743:Pyrimidines / Q000008:administration & dosage / Q000009:adverse effects*; D000069283:Rituximab / Q000008:administration & dosage*; D012867:Skin / Q000187:drug effects* / Q000276:immunology / Q000473:pathology; D018417:Th1 Cells / Q000187:drug effects* / Q000276:immunology; D018418:Th2 Cells / Q000187:drug effects* / Q000276:immunology; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D060890:B7-H1 Antigen; D014408:Biomarkers, Tumor; C423236:CD274 protein, human; C508609:IL10 protein, human; D016756:Immunoglobulins, Intravenous; D010880:Piperidines; D047428:Protein Kinase Inhibitors; D011720:Pyrazoles; D011743:Pyrimidines; D016753:Interleukin-10; C551803:ibrutinib; D000069283:Rituximab; D000225:Adenine