Despite Tolerance of Imatinib Prior to Transplant, Imatinib Induces Prolonged Exanthematous Pustulosis in a Patient with Sclerodermatous Graft-Versus-Host Disease: A Case Report.
Bibliographic record
Abstract
Abstract Abstract 4670 Treatment of sclerodermatous chronic graft versus host disease (cGVHD) remains a daunting challenge. Despite developments in prophylaxis for cGVHD, supportive care measures remain as the primary mode of therapy, with little evidence of treatments that reverse the process. Steroids and immunosuppressants are often ineffective, and extracorporeal photopheresis has been used with varying success. Recently, case reports have reported on the successful use of imatinib in treating sclerodermatous GVHD (Moreno-Romero et al, 2008; Leonardo Magro et al., 2009). We report a case of a 40-year-old male patient with extensive sclerodermatous cGVHD. In 2005 he underwent an unrelated stem cell transplant (SCT) for chronic myeloid leukemia. His transplant course was complicated by thrombotic thrombocytopenic purpura (TTP) associated with all standard immunosuppressive drugs (cyclosporine, tacrolimus and sirolimus). Two years later, the patient developed sclerodermatous GVHD and was given plaquenil, steroids, and photopheresis to manage this complication. Unfortunately, after months of treatment, he showed progressive disease, including increased contractures, and difficulties with inspiration. Based on case reports, and the patient's tolerance of imatinib prior to SCT, he was started on imatinib for his sclerodermatous GVHD. Within 5 days he developed generalized erythema, pustular rash, and skin sloughing (Figure 1). He was hospitalized for this severe reaction and was treated with high dose steroids after which, his symptoms began to improve. Resolution of erythema did not occur until months following initial exposure. Histological differential diagnosis included pustular psoariasis and Sneedon-Wilkinson syndrome. The skin biopsy revealed subcorneal pustular dermatosis (Figure 2). In view of this history, it is suggested that the exanthematous pustulosis was induced by imatinib in this patient. We recommend that close attention is paid to patients with cGHVD who are treated with imatinib and to intervene early in those who develop severe cutaneous reactions by stopping imatinib and starting appropriate therapy. Figure 1 SEQ – Imatinib induced generalized erythema, pustular rash, and skin sloughing developed five days into treatment. Figure 1. SEQ – Imatinib induced generalized erythema, pustular rash, and skin sloughing developed five days into treatment. Figure 2 SEQ - skin biopsy revealing subcorneal pustular dermatosis Figure 2. SEQ - skin biopsy revealing subcorneal pustular dermatosis Disclosures: No relevant conflicts of interest to declare.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.003 |
| Meta-epidemiology (narrow) | 0.002 | 0.002 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.004 | 0.003 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".