Case Report Dermatology 2002;205:172–173 Pityriasis rosea Associated with Imatinib (STI571, Gleevec) K. Konstantopoulos A. Papadogianni M. Dimopoulou C. Kourelis J. Meletis First Department of Medicine, University of Athens School of Medicine at Laikon Hospital, Athens, Greece Received: January 17, 2001 Accepted: February 7, 2002 Dr. K. Konstantopoulos First Department of Medicine, Athens University Medical School 75 M. Asias Str. Athens 11527 (Greece) Tel. +30 10 6537421, Fax +30 10 6537421, E-Mail kkonstan@med.uoa.gr ABC Fax + 41 61 306 12 34 E-Mail karger@karger.ch www.karger.com © 2002 S. Karger AG, Basel 1018–8665/02/2052–0172$18.50/0 Accessible online at: www.karger.com/journals/drm Key Words Adverse drug reaction W STI571 W Leukemia W Gleevec Abstract A tyrosine kinase inhibitor (STI571, Gleevec) has recently been applied in the treatment of chronic myeloid leukemia. We present the first reported case of pityriasis rosea occurring as a reaction to Gleevec in a wom- an with blast crisis of this disorder. It is sug- gested that although coincidental, this exan- them may be due to this agent. Copyright © 2002 S. Karger AG, Basel Introduction Pityriasis rosea (PR) is a papulosqua- mous eruption of unclear etiology; it is char- acterized by the consecutive development of a 2- to 6-cm annular red lesion (‘herald patch’) followed in a few days to a few weeks by many smaller lesions of the same appear- ance. The eruption tends to occur on the trunk, it is moderately pruritic and lasts 3–8 weeks. As far as the causative agent(s), sever- al factors are discussed, namely viruses [1], chemicals and drugs [2]. We report a case of a women with PR developing this exanthem following intro- duction of STI571, a selective inhibitor of BCR-ABL tyrosine kinase, that has recently been introduced in the management of chronic myeloid leukemia (CML). Case Report A 42-year-old white female was admitted for blast crisis of CML. The personal history was negative for drug allergy and exposure to toxins. She was diagnosed as having Phila- delphia-chromosome positive CML; chro- mosomal abnormality was further con- firmed by a molecular analysis (b2a2). She was initially treated with hydroxyurea alone as she did not accept to be subjected to bone marrow transplantation from an HLA- matched identical sibling. Following 24 months of treatment, she presented with lymph node enlargement and fever. Peripheral blood hematology and bone marrow aspirate indicated blast crisis; a new chromosomal typing revealed addi- tionally the isochromosome 17 abnormality, thus confirming evolution to blast crisis. She was admitted to the hospital where following her informed consent she was administered Gleevec for 40 days (daily dose: 40 mg ! 1 per os) responding poorly. After 4 weeks of Gleevec administration, she consecutively presented with typical PR skin eruptions, namely a ‘herald patch’ followed within a week by smaller patches of the same appear- ance. Administration of Gleevec was contin- ued for a few days, whereas pruritus was treated with oral antihistamines. Finally, she was given idarubicin, cytarabine and ste- roids with no results as far as leukemia con- trol was concerned. She died within the next few days due to a respiratory tract infection. Discussion The clinical presentation of the exan- them is typically that of a PR. The case can be considered as having PR following Glee- vec because of the short interval between administration and onset of the eruption. Although skin biopsy was prohibited by se- vere thrombopenia, according to the clinical criterion the diagnosis of PR must be consid- ered as definite. PR has been associated with human her- pesviruses infection, namely, herpes virus 6 and herpes virus 7 are implicated [1, 3, 4]. However, PR occurring as a drug reaction following administration of drugs or expo- sure to chemicals is also reported: gold salts [5], benflurafine [6], terbinafine [7], omepra- zole [8], and metronidazole [9], as well as several vaccines (HBV [10], BCG), are re- ported as potential causative or contributing factors for PR appearing. It is also reported as a manifestation in the course of interferon treatment for Behçet’s disease [11]. It can Downloaded by: University of Edinburgh 129.215.17.190 - 11/24/2018 3:12:28 AM