Imatinib

Abstract

Hypersensitivity pneumonitis, skin rash and eyelid oedema: case reportA 61-year-old man developed hypersensitivity pneumonitis, skin rash and eyelid oedema during treatment with imatinib for chronic myeloid leukaemia (CML) [route not stated; not all durations of treatment to reaction onsets and outcomes stated].The man in Tunisia, who was a heavy cigarette smoker with 40 pack-year history, was diagnosed with Philadelphia positive CML. He initially received hydroxycarbamide [hydroxyurea] and allopurinol for one month. Then, the treatment was switched to imatinib [imatinib mesylate] 400 mg/day. However, within one month of treatment, he developed diffuse, pruriginous skin lesions on the face, the neck, and the upper limbs. Unspecified dermocorticoids improved these cutaneous lesions. After two weeks (45 days of imatinib treatment), he developed dyspnoea and non-productive cough, for which he was admitted to a hospital. Physical examination revealed skin rash and eyelid oedema. Vital signs measurement and complete blood count was performed. Chest x-ray showed bilateral reticulonodular infiltration in both lungs, which was further confirmed by high-resolution lung CT. Bronchoscopy with bronchoalveolar lavage was also performed. Infectious pneumonia was ruled out by negative results of biological culture tests. Hence, imatinib-induced hypersensitivity pneumonitis was diagnosed.The man's imatinib treatment was discontinued and prednisolone was started. Dyspnoea, abnormal X-ray and CT findings improved after two weeks. Significant improvement was observed after three months. However, he had persistent emphysema. He was prescribed nilotinib for CML.