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Interphase Cytogenetic Detection of BCR-ABL– Positive Lesional Cells

Kjell Matthias Kaune, MD; Mario Baumgart, MSc; Stefan Gesk, MD; Christina Mitteldorf, MD; Joerg Baesecke, MD; Bertram Glass, MD; Detlef Haase, MD; Reiner Siebert, MD; B. Michael Ghadimi, MD; Christine Neumann, MD; Steffen Emmert, MD

Arch Dermatol. 2008;144(3):361-364.

Background  An association of Sweet syndrome with chronic myeloid leukemia (CML) has been recently observed in patients treated with tyrosine kinase inhibitors.

Observations  We describe a 67-year-old patient with a 6-year history of Philadelphia chromosome translocation t(9;22)(q34;q11)-positive CML. The tyrosine kinase inhibitor AMN107 (nilotinib) kept the patient in chronic phase. After 10 months of taking nilotinib, he developed pneumonia with septic features. Seven days later, bullous skin infiltrations on the upper arms and a large, painful bullous swelling of the right neck occurred without any evidence of a viral, bacterial, or fungal blood infection. Findings from histologic examination showed massive infiltrations of the whole dermis with neutrophil granulocytes as well as with monocytoid histiocytic cells. Fluorescence in situ hybridization analysis of paraffin-embedded tissue revealed a BCR-ABL fusion, indicating the presence of t(9;22)(q34;q11). The addition of oral prednisolone to an adequate antibiotic treatment led to rapid resolution of the cutaneous infiltrations.

Conclusions  Skin infiltrations consistent with Sweet syndrome can occur in patients with septic CML during the treatment with tyrosine kinase inhibitors, including nilotinib. Skin infiltrations can include specific CML cells.

Author Affiliations: Departments of Dermatology and Venerology (Drs Kaune, Mitteldorf, Neumann, and Emmert), General and Visceral Surgery (Mr Baumgart and Dr Ghadimi), and Hematology and Oncology (Drs Baesecke, Glass, and Haase), Georg-August-University Goettingen, Goettingen, Germany; and Institute of Human Genetics, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany (Drs Gesk and Siebert).

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