C. Ibrutinib-induced toxic effects
Ibrutinib is a selective Bruton tyrosine kinase inhibitor used for treatment of several lymphoproliferative disorders, including CLL, mantle cell lymphoma, marginal zone lymphoma, and Waldenström macroglobulinemia. Skin eruptions represent a frequent adverse effect of the medication and are seen in up to 47% of patients who take it.1
A retrospective cohort study by Iberri et al2 reported 2 main types of skin eruptions associated with ibrutinib use: an asymptomatic, nonpalpable, petechial rash, and a palpable, purpuric eruption resembling leukocytoclastic vasculitis (LCV). The nonpalpable eruption had late rash onset (80 days after initiation of the drug on average) and mild associated symptoms. The palpable eruption was associated with earlier rash onset (15 days after initiation of the drug on average) and worse severity, requiring temporary interruption of ibrutinib therapy in some of the patients. All the patients who required temporary interruption of therapy were able to resume ibrutinib.2 Histopathology of the eruptions revealed perivascular and interstitial inflammation and erythrocyte extravasation with no evidence of LCV.