International Journal of Hematology

, Volume 95, Issue 3, pp 311–314

Generalized purpuric drug exanthem with hemorrhagic plaques following bendamustine chemotherapy in a patient with B-prolymphocytic leukemia

  • Aruna Gavini
  • Gladys H. Telang
  • Adam J. Olszewski
Case Report

Abstract

A 72-year-old woman presented with dyspnea and lower extremity edema. Extreme lymphocytosis, cytopenia, and splenomegaly were found, and she was diagnosed with B-prolymphocytic leukemia. Following the first dose of therapy with bendamustine, the patient developed severe generalized maculopapular rash, which subsequently progressed to exuberant, non-blanching palpable purpura with hemorrhagic plaques suspicious for leukocytoclastic vasculitis. These events coincided with severe chemotherapy-induced neutropenia and thrombocytopenia, but there were no clinical symptoms of infection. Skin punch biopsy revealed perivascular and diffuse upper dermal lymphocytic infiltrate with eosinophils and marked erythrocyte extravasation consistent with a purpuric drug exanthem. The patient was treated with steroids, with complete resolution of the findings. This new form of cutaneous toxicity of bendamustine is presented along with a review of previous experience with the drug.

Keywords

Bendamustine Drug eruption Prolymphocytic leukemia Vasculitis Chronic lymphoid leukemia 

References

  1. 1.
    Hunder GG, Arend WP, Bloch DA, Calabrese LH, Fauci AS, Fries JF, et al. The American College of Rheumatology 1990 criteria for the classification of vasculitis. Introduction. Arthritis Rheum. 1990;33:1065–7.PubMedCrossRefGoogle Scholar
  2. 2.
    Dungarwalla M, Matutes E, Dearden CE. Prolymphocytic leukaemia of B- and T-cell subtype: a state-of-the-art paper. Eur J Haematol. 2008;80:469–76.PubMedCrossRefGoogle Scholar
  3. 3.
    Schlette E, Bueso-Ramos C, Giles F, Glassman A, Hayes K, Medeiros LJ. Mature B-cell leukemias with more than 55% prolymphocytes. A heterogeneous group that includes an unusual variant of mantle cell lymphoma. Am J Clin Pathol. 2001;115:571–81.PubMedCrossRefGoogle Scholar
  4. 4.
    Lens D, De Schouwer PJ, Hamoudi RA, Abdul-Rauf M, Farahat N, Matutes E, et al. p53 abnormalities in B-cell prolymphocytic leukemia. Blood. 1997;89:2015–23.PubMedGoogle Scholar
  5. 5.
    Robak T, Robak P. Current treatment options in prolymphocytic leukemia. Med Sci Monit. 2007;13:RA69–80.PubMedGoogle Scholar
  6. 6.
    Leoni LM, Bailey B, Reifert J, Bendall HH, Zeller RW, Corbeil J, et al. Bendamustine (Treanda) displays a distinct pattern of cytotoxicity and unique mechanistic features compared with other alkylating agents. Clin Cancer Res. 2008;14:309–17.PubMedCrossRefGoogle Scholar
  7. 7.
    Knauf WU, Lissichkov T, Aldaoud A, Liberati A, Loscertales J, Herbrecht R, et al. Phase III randomized study of bendamustine compared with chlorambucil in previously untreated patients with chronic lymphocytic leukemia. J Clin Oncol. 2009;27:4378–84.PubMedCrossRefGoogle Scholar
  8. 8.
    Roué G, López-Guerra M, Milpied P, Pérez-Galán P, Villamor N, Montserrat E, et al. Bendamustine is effective in p53-deficient B-cell neoplasms and requires oxidative stress and caspase-independent signaling. Clin Cancer Res. 2008;14:6907–15.PubMedCrossRefGoogle Scholar
  9. 9.
    Stilgenbauer S, Zenz T. Understanding and managing ultra high-risk chronic lymphocytic leukemia. Hematology Am Soc Hematol Educ Program. 2010;2010:481–8.PubMedCrossRefGoogle Scholar
  10. 10.
    Treanda [package insert]. Frazer: Cephalon, Inc.; 2008.Google Scholar
  11. 11.
    Ramdial PK, Naidoo DK. Drug-induced cutaneous pathology. J Clin Pathol. 2009;62:493–504.PubMedCrossRefGoogle Scholar
  12. 12.
    Ardern-Jones MR, Friedmann PS. Skin manifestations of drug allergy. Br J Clin Pharmacol. 2011;71:672–83.PubMedCrossRefGoogle Scholar
  13. 13.
    Alamdari HS, Pinter-Brown L, Cassarino DS, Chiu MW. Severe cutaneous interface drug eruption associated with bendamustine. Dermatol Online J. 2010;16:1.PubMedGoogle Scholar
  14. 14.
    Gerson D, Sriganeshan V, Alexis JB. Cutaneous drug eruptions: a 5-year experience. J Am Acad Dermatol. 2008;59:995–9.PubMedCrossRefGoogle Scholar
  15. 15.
    Ghersetich I, Comacchi C, Jorizzo JL, Katsambas A, Lotti TM. Proposal for a working classification of cutaneous vasculitis. Clin Dermatol. 1999;17:499–503.PubMedCrossRefGoogle Scholar
  16. 16.
    Hautmann G, Campanile G, Lotti TM. The many faces of cutaneous vasculitis. Clin Dermatol. 1999;17:515–31.PubMedCrossRefGoogle Scholar
  17. 17.
    Walsh SA, Creamer D. Drug reaction with eosinophilia and systemic symptoms (DRESS): a clinical update and review of current thinking. Clin Exp Dermatol. 2011;36:6–11.PubMedCrossRefGoogle Scholar

Copyright information

© The Japanese Society of Hematology 2012

Authors and Affiliations

  • Aruna Gavini
    • 1
  • Gladys H. Telang
    • 2
  • Adam J. Olszewski
    • 3
  1. 1.Department of Hematology/OncologyRoger Williams Medical CenterProvidenceUSA
  2. 2.Department of Dermatology, Rhode Island HospitalAlpert Medical School of Brown UniversityProvidenceUSA
  3. 3.Division of Hematology/Oncology, Memorial Hospital of Rhode IslandAlpert Medical School of Brown UniversityPawtucketUSA

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