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Haemorrhagic cerebral infarction and drug rash: case report A man in his late 50s developed haemorrhagic cerebral infarction during treatment with heparin for Trousseau syndrome. Additionally, he developed drug rash during treatment with rosuvastatin and ponatinib [not all indications, routes, dosages, durations of treatments to reactions onsets and outcomes stated] The man, who had abnormal glucose tolerance, presented with lower back pain. His local doctor noted platelet count of 4.1 × 104 /µL and peripheral blood cells at 5%. Therefore, he was referred to another hospital. Upon hospitalisation in Japan, he had fibrin and fibrinogen degradation product value of 122µg/mL. After thorough investigation, he was diagnosed with Philadelphia chromosome-positive acute lymphoblastic leukaemia (Ph+ALL). He received remission induction therapy comprising daunorubicin, cyclophosphamide, vincristine and imatinib (JALSG Ph+ALL 208 protocol). However, on day 2 of chemotherapy, he developed left visual field defect and cerebral infarction, which was attributed to mild glucose intolerance. He was diagnosed with Trousseau syndrome accompanied by a malignant tumour. Therefore, he additionally started receiving anticoagulant therapy with heparin [route and dosage not stated]. However, on day 9, he developed haemorrhagic cerebral infarction on the opposite side. Although the endometrial blasts disappeared and an antitumour effect was achieved, he was found to be in Japan Coma Scale 300 and JALSG Ph+ALL 208 protocol was discontinued. After improvement in consciousness and absorption of cerebral haemorrhage, he received dasatinib, which was temporarily successful. However, disease recurred after 5 months. Therefore, he started receiving oral ponatinib 15 mg/day along with rosuvastatin calcium [rosuvastatin]. The dose of ponatinib was gradually increased to 30 mg/day over the period of 8 days and ponatinib was continued at the same dose thereafter. Complete molecular genetic remission was confirmed on day 52 of therapy. Meanwhile, he developed grade 2 drug rash, which was attributed to rosuvastatin and ponatinib. There was no recurrence of disease or cerebral infarction, therefore treatment was continued. Author comment: The 208 protocol was continued with anticoagulant therapy. . .however on day 9 the patient had a haemorrhagic cerebral infarction on the opposite side.. . .Ponatinib 15 mg/day in combination with rosuvastatin calcium was then introduced. . .Grade 2 (G2) drug rash was the only side effect. "HCI is hemorrhagic transformation after [cerebral infarction] that is frequent complication especially common after thrombotic therapy." Fujii T, et al. [A Case of Philadelphia Chromosome-Positive Acute Lymphoblastic Leukemia Achieving Complete Molecular Response with Ponatinib Therapy despite the Development of Hemorrhagic Stroke during Remission Induction Chemotherapy]. [Japanese]. Gan to Kagaku Ryoho 46: 1795-1797, No. 11, 2019. Available from: URL: https://www.ncbi.nlm.nih.gov/ pubmed?cmd=search&orig_db=PubMed&term=0385-0684