Eosinophilic dermatosis of haematologic malignancy treated with ibrutinib: A case report

Giulia Greta Dradi, Reyes Gamo Villegas, Fernando Pinedo Moraleda, Jose Luis López Estebaranz
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Abstract

Eosinophilic dermatosis of haematologic malignancy is an infrequent skin disorder characterised by severe pruritus and skin lesions resembling arthropod bites. It primarily affects individuals with underlying haematological conditions, most commonly chronic lymphocytic leukaemia (CLL). While it does not correlate with a worse prognosis for the haematological disease itself, it significantly impacts patients' quality of life due to the distressing pruritus and recurring nature. Clinical presentation typically shows erythematous papules resembling arthropod bites, with less frequent occurrences of urticarial plaques or bullous lesions. Histologically, an intense and polymorphous inflammatory infiltrate is found both in the superficial and deep dermis, marked by an abundance of eosinophils and the absence of atypical cells. Treatment of this disease remains uncertain, with corticosteroids often being the only effective therapy. Here, we present the case of an 80-year-old patient with a history of CLL, who experienced a widespread, itchy eruption of papules and plaques over 2 months. Despite various therapeutic attempts, the lesions only responded to high-dose corticosteroids. Following the initiation of ibrutinib at a daily dose of 420 mg, both the skin lesions and pruritus resolved within 3 months. Ibrutinib, a tyrosine kinase inhibitor, is approved as a first-line treatment for CLL. However, its potential as a remedy for refractory eosinophilic dermatosis has not been reported thus far.

Abstract Image

伊鲁替尼治疗恶性血液病嗜酸性皮肤病1例
血液恶性肿瘤嗜酸性粒细胞皮肤病是一种不常见的皮肤病,其特征是剧烈瘙痒和类似节肢动物叮咬的皮损。它主要影响患有基础血液病的患者,最常见的是慢性淋巴细胞白血病(CLL)。虽然它与血液病本身的不良预后无关,但由于其瘙痒和反复发作的特性,会严重影响患者的生活质量。临床表现通常表现为类似节肢动物叮咬的红斑丘疹,较少出现荨麻疹斑或大疱性皮损。在组织学上,真皮浅层和深层均可发现强烈的多形性炎症浸润,其特点是嗜酸性粒细胞多而非典型细胞少。这种疾病的治疗方法仍不确定,皮质类固醇通常是唯一有效的治疗方法。在此,我们介绍一例 80 岁患者的病例,该患者有 CLL 病史,在 2 个月内出现广泛的丘疹和斑块,瘙痒难忍。尽管尝试了各种治疗方法,但皮损仅对大剂量皮质类固醇激素有反应。在开始使用每日剂量为420毫克的伊布替尼后,皮损和瘙痒均在3个月内缓解。伊布替尼是一种酪氨酸激酶抑制剂,已被批准作为CLL的一线治疗药物。然而,迄今为止,尚未有报道称伊布替尼可用于治疗难治性嗜酸性粒细胞皮肤病。
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