Ibrutinib
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Pyoderma gangrenosum: case report A 55-year-old man developed pyoderma gangrenosum during treatment with ibrutinib for B-cell chronic lymphocytic leukaemia (B-CLL). The man, who had chronic lymphocytic leukaemia, was successfully treated with short-course of unspecified systemic steroids followed by fludarabine, cyclophosphamide and rituximab for 6 cycles and achieved a partial remission. After 2 years (May 2018), a relapse occurred. He was noted to have an acute onset of autoimmune haemolytic anaemia. He was treated with high-dose steroids (unspecified) and rituximab. The pretreatment diagnostic work-up showed disease progression with diffuse enlarged lymph nodes and mild splenomegaly. A bone marrow infiltration of around 70% of CLL cells and mutation on the p53 and the p17 deletion on the other allele. Then, he started receiving ibrutinib 420 mg/die [route not stated]. Within 2 weeks a significant improvements were noted. After 5 months of ibrutinib therapy, he developed multiple, painful erythematous to violaceous nodules and pustules on abdomen and thighs that rapidly evolved in painful ulcer with undermined violaceous borders. He had been receiving antiviral prophylaxis with valaciclovir [valacyclovir], which was stopped. A biopsy from ulcer margin demonstrated massive neutrophil infiltration with leucocytoclasia and marked tissue necrosis with surrounding mononuclear cell infiltrates. Based on the investigations, he was diagnosed with pyoderma gangrenosum, and ibrutinib was suspected as causative agent. Subsequently, the man was treated with prednisone, which was slowly tapered every 3 weeks. The dose of ibrutinib was reduced to 210 mg/die due to risk of further disease progression. Eventually, an improvement of skin lesion was noted. He also received dapsone treatment. Subsequently, ibrutinib therapy was changed to venetoclax. Later, it was confirmed that his pyoderma gangrenosum was associated with ibrutinib [duration of treatment to reaction onset and outcome not stated]. Giovanni B, et al. Ibrutinib and Pyoderma Gangrenosum in a Patient With B-Cell Chronic Lymphocytic Leukemia. American Journal of Dermatopathology 42: 148-150, No. 803519954 2, Feb 2020. Available from: URL: http://doi.org/10.1097/DAD.0000000000001391
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Reactions 12 Dec 2020 No. 1834
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