Recurrent neutrophilic panniculitis in a patient with chronic myelogenous leukaemia treated with imatinib mesilate and dasatinib

Background. - Tyrosine kinase inhibitors are now established as valuable therapy in chronic myelogenous leukaemia (CML). They induce several types of cutaneous side effect, the most common being non-specific maculopapular rash and periocular oedema. Rare cases of panniculitis have been described in patients with CML treated with imatinib mesilate and dasatinib. We report a case of recurrent panniculitis in a patient with CML treated successively with imatinib mesilate and dasatinib. Case report. - An 81-year-old woman diagnosed with chronic CML experienced two episodes of neutrophilic panniculitis following imatinib mesilate therapy, as well as relapse following replacement of imatinib mesilate by dasatinib. Several skin biopsies showed a neutrophilic infiltrate throughout the fatty tissue lobules, without vasculitis and without any evidence of bacterial infection. The symptoms gradually subsided without discontinuation of tyrosine kinase inhibitor therapy. Discussion. - Neutrophilic panniculitis is uncommon among patients treated with tyrosine kinase inhibitors and has only been described in patients treated for chronic myeloid leukaemia. We discuss the potential causative role of imatinib mesilate and dasatinib in onset of the disease, as well as differential diagnosis of neutrophilic panniculitis, which resembles subcutaneous Sweet's syndrome. (C) 2010 Elsevier Masson SAS. All rights reserved.