Three weeks after starting imatinib, J.L. comes to the hospital to report persistent fever and a large maculopapular eruption on his face, abdomen, and lower limbs. On examination, his temperature is 38.2ºC, and lesions caused by pruritus are noted. Laboratory tests show:

- Total bilirubin: 2 mg/dL (range 0.4-1.4)
- SCr: 1.8 mg/dL
- WBC: 2876 cells/mm³ eosinophils (reference range 2-500)

J.L. is ultimately diagnosed with drug reaction with eosinophilia and systemic symptoms (DRESS). Which one of the following is best to recommend for J.L.?

A. Discontinue imatinib and start low-dose prednisolone at 0.5 mg/kg once daily.
B. Continue imatinib and start low-dose prednisolone at 0.5 mg/kg once daily.
C. Continue imatinib because the patient's condition is largely self-limiting.
D. Discontinue imatinib because the patient's chronic kidney disease is worsening.

Question

06-12-2023
Medicine

College

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Three weeks after starting imatinib, J.L. comes to the hospital to report persistent fever and a large maculopapular eruption on his face, abdomen, and lower limbs. On examination, his temperature is 38.2ºC, and lesions caused by pruritus are noted. Laboratory tests show:

- Total bilirubin: 2 mg/dL (range 0.4-1.4)
- SCr: 1.8 mg/dL
- WBC: 2876 cells/mm³ eosinophils (reference range 2-500)

J.L. is ultimately diagnosed with drug reaction with eosinophilia and systemic symptoms (DRESS). Which one of the following is best to recommend for J.L.?

A. Discontinue imatinib and start low-dose prednisolone at 0.5 mg/kg once daily.
B. Continue imatinib and start low-dose prednisolone at 0.5 mg/kg once daily.
C. Continue imatinib because the patient's condition is largely self-limiting.
D. Discontinue imatinib because the patient's chronic kidney disease is worsening.

Answer :

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VaeeWilson VaeeWilson · Answer 1 · 2024-03-08T15:25:24-05:00

A. Discontinue imatinib and start low-dose prednisolone at 0.5 mg/kg once daily.

J.L. presents with persistent fever, a maculopapular rash, and elevated eosinophils shortly after starting imatinib. These clinical signs, along with the laboratory findings, suggest drug reaction with eosinophilia and systemic symptoms (DRESS).

DRESS is a severe hypersensitivity reaction, which requires immediate intervention to prevent further complications, including organ failure. In this case, it is important to discontinue the offending drug, imatinib, immediately. Additionally, treatment with corticosteroids such as prednisolone can help manage the inflammation and immune response associated with DRESS.