Imatinib-Induced Lichenoid Drug Eruption with Nail Involvement in a Patient with Chronic Myeloid Leukaemia: A Case Report

Abstract

Aims: To describe imatinib-induced lichenoid drug eruption with nail involvement in a patient receiving treatment for chronic myeloid leukaemia. Study Design: Case report. Place and Duration of Study: Department of Dermatology, Ibn Sina Hospital. Methodology: A 63-year-old man with chronic myeloid leukaemia developed generalised pruritus, leucocytosis and eosinophilia one month after starting imatinib at a dose of 800 mg/day. Dermatological examination showed hyperpigmented, infiltrated and scaly plaques that began on the neck and later involved the face, trunk and upper limbs, with marked facial hyperpigmentation. Nail examination revealed trachyonychia, longitudinal ridging and dystrophic changes. Lichenoid cheilitis was present, while the genital mucosa was unaffected. Dermoscopy showed perifollicular pigmentation without Wickham striae. Skin biopsy demonstrated epidermal acanthosis, lymphocytic infiltrate with eosinophils and pigment incontinence, supporting a diagnosis of lichenoid drug eruption. Mycological examination of nail scrapings was negative. Haemoglobin levels and thyroid function tests were normal, and serum ferritin was at the lower limit of the normal reference range. Results: Topical corticosteroids and oral antihistamines provided only partial relief while imatinib was continued. In view of the chronology, clinical morphology and histopathological findings, imatinib was discontinued and replaced with dasatinib. Pruritus and cutaneous lesions progressively improved within two months after withdrawal of imatinib, and no recurrence was observed during follow-up after treatment was switched. Conclusion: This case supports imatinib-induced lichenoid drug eruption as an uncommon cutaneous adverse effect that may be accompanied by nail abnormalities. Recognition of this presentation may assist timely dermatological assessment and multidisciplinary management while allowing continuation of leukaemia treatment through an alternative tyrosine kinase inhibitor.